docs-#680488-v1-revised mccready conversion con tablesuhfhqwo\ lq wkh idoo ri 0f&uhdg\ +rvslwdo...
TRANSCRIPT
MODIFIED REQUEST FOR EXEMPTION FROM CERTIFICATE OF NEED REVIEW
McCready Foundation d/b/a Edward W. McCready Hospital andPeninsula Regional Medical Center, Inc.
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“c
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See
In re Dimensions Health Corporation
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Emergency Department Design: A Practical Guide to Planning for the Future,
See
Emergency Department Design: A Practical Guide to Planning for the Future
See
There’s no “if you see ‘X’ number of patients in a year, your department should be ‘Y’ square feet with ‘Z’ number of patient care spaces.”
Emergency Department Design: A Practical Guide to Planning for the Future,
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Bed Need Calc
Explanation of Extraordinary Costs
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Counsel for Peninsula Regional Medical Center, Inc.
#670712012888-0002
I hereby declare and affirm under the penalties of perjury that the facts stated in
the Modified Request for Exemption from CON Review to Convert McCready Hospital
to a Freestanding Medical Facility and its exhibits are true and correct to the best of my
knowledge, information, and belief.
10/23/19Date Andrew L. Solberg
A.L.S. Healthcare Consultant Services
EXHIBIT 1
(Spe
cify
/add
row
s as
ne
eded
) (Spe
cify
/add
row
s as
ne
eded
)(S
peci
fy/a
dd ro
ws
as
need
ed)
INST
RU
CTI
ON
S: Id
entif
y th
e lo
catio
n of
eac
h nu
rsin
g un
it (a
dd o
r del
ete
row
s if
nece
ssar
y) a
nd s
peci
fy th
e ro
om a
nd b
ed c
ount
bef
ore
and
afte
r the
pro
ject
in a
ccor
danc
e w
ith th
e de
finiti
on o
f phy
sica
l cap
acity
not
ed b
elow
. App
lican
ts s
houl
d ad
d co
lum
ns a
nd re
calc
ulat
e fo
rmul
as to
add
ress
room
s w
ith 3
and
4 b
ed c
apac
ity. N
OTE
: Phy
sica
l cap
acity
is th
e to
tal n
umbe
r of b
eds
that
cou
ld b
e ph
ysic
ally
set
up
in s
pace
with
out s
igni
fican
t ren
ovat
ions
. Thi
s sh
ould
be
the
max
imum
ope
ratin
g ca
paci
ty u
nder
nor
mal
, non
-em
erge
ncy
circ
umst
ance
s an
d is
a p
hysi
cal c
ount
of b
ed c
apac
ity, r
athe
r tha
n a
mea
sure
of s
taffi
ng c
apac
ity. A
room
with
two
head
wal
ls a
nd tw
o se
ts o
f gas
ses
shou
ld b
e co
unte
d as
hav
ing
capa
city
for t
wo
beds
, eve
n if
it is
typi
cally
set
up
and
oper
ated
with
onl
y on
e be
d. A
room
with
one
hea
dwal
l and
one
set
of g
asse
s is
cou
nted
as
a pr
ivat
e ro
om, e
ven
if it
is la
rge
enou
gh fr
om a
squ
are
foot
age
pers
pect
ive
to b
e us
ed a
s a
sem
i-priv
ate
room
, sin
ce
reno
vatio
n/co
nstr
uctio
n w
ould
be
requ
ired
to c
onve
rt it
to s
emi-p
rivat
e us
e. I
f the
hos
pita
l ope
rate
s pa
tient
room
s th
at c
onta
in n
o he
adw
alls
or a
sin
gle
head
wal
l, bu
t are
nor
mal
ly u
sed
to a
ccom
mod
ate
one
or m
ore
than
one
pat
ient
(e.g
., fo
r psy
chia
tric
pa
tient
s), t
he p
hysi
cal c
apac
ity o
f suc
h ro
oms
shou
ld b
e co
unte
d as
they
are
cur
rent
ly u
sed.
INS
TRU
CTI
ON
: Add
or d
elet
e ro
ws
if ne
cess
ary.
See
add
ition
al in
stru
ctio
n in
the
colu
mn
to th
e rig
ht o
f the
tabl
e.
INSTRUCTION : If project includes non-hospital space structures (e.g., parking garges, medical office buildings, or energy plants), complete an additional Table C for each structure.
(Specify/add rows if needed)
INSTRUCTION : If project includes non-hospital space structures (e.g., parking garges, medical office buildings, or energy plants), complete an additional Table D for each structure.
Hospital Building Other Structure Total
SUBTOTAL
SUBTOTAL
(Specify/add rows if needed)SUBTOTAL $0 $8,654,583TOTAL CURRENT CAPITAL COSTSLand Purchase
TOTAL CAPITAL COSTS
c1. Legal Fees c2. Other (Specify/add rows if needed)
d1. Legal Feesd2. Other (Specify/add rows if needed)
(Specify/add rows if needed)SUBTOTAL $0 $322,228
TOTAL USES OF FUNDS $138,778 $25,450,516 $25,589,294
(Specify/add rows if needed)TOTAL SOURCES OF FUNDS $0 $25,589,294 $25,589,294
Hospital Building Other Structure Total
INSTRUCTION : Estimates for Capital Costs (1.a-e), Financing Costs and Other Cash Requirements (2.a-g), and Working Capital Startup Costs (3) must reflect current costs as of the date of application and include all costs for construction and renovation. Explain the basis for construction cost estimates, renovation cost estimates, contingencies, interest during construction period, and inflation in an attachment to the application.
NOTE : Inflation should only be included in the Inflation allowance line A.1.e. The value of donated land for the project should be included on Line A.1.d as a use of funds and on line B.8 as a source of funds
(Specify/add rows if needed)
Indi
cate
CY
or F
Y
Tota
l MSG
A
Tota
l Acu
te28
022
818
593
00
00
00
TOTA
L D
ISC
HA
RG
ES28
022
818
593
00
00
00
Tota
l MSG
A
Tota
l Acu
te86
475
961
330
70
00
00
0
TOTA
L PA
TIEN
T D
AY S
864
759
613
307
00
00
00
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. I
ndic
ate
on th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
For
sect
ions
4 &
5, t
he n
umbe
r of b
eds
and
occu
panc
y pe
rcen
tage
sho
uld
be re
porte
d on
the
basi
s of
lice
nsed
bed
s. In
an
atta
chm
ent t
o th
e ap
plic
atio
n, p
rovi
de a
n ex
plan
atio
n or
bas
is
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
App
lican
ts m
ust e
xpla
in w
hy th
e as
sum
ptio
ns a
re re
ason
able
.
Indi
cate
CY
or F
Y
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. I
ndic
ate
on th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
For
sect
ions
4 &
5, t
he n
umbe
r of b
eds
and
occu
panc
y pe
rcen
tage
sho
uld
be re
porte
d on
the
basi
s of
lice
nsed
bed
s. In
an
atta
chm
ent t
o th
e ap
plic
atio
n, p
rovi
de a
n ex
plan
atio
n or
bas
is
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
App
lican
ts m
ust e
xpla
in w
hy th
e as
sum
ptio
ns a
re re
ason
able
.
Tota
l MSG
A
Tota
l Acu
te
TOTA
LA
VER
AG
ELE
NG
THO
FST
AY
Tota
l MSG
A
Tota
l Acu
te3
33
30
00
00
0
TOTA
L LI
CEN
SED
BED
S3
33
30
00
00
0
Indi
cate
CY
or F
Y
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. I
ndic
ate
on th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
For
sect
ions
4 &
5, t
he n
umbe
r of b
eds
and
occu
panc
y pe
rcen
tage
sho
uld
be re
porte
d on
the
basi
s of
lice
nsed
bed
s. In
an
atta
chm
ent t
o th
e ap
plic
atio
n, p
rovi
de a
n ex
plan
atio
n or
bas
is
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
App
lican
ts m
ust e
xpla
in w
hy th
e as
sum
ptio
ns a
re re
ason
able
.
Tota
l MSG
A
Tota
l Acu
te
TOTA
L O
CC
UPA
NC
Y %
TOTA
L O
UTP
ATI
ENT
VISI
T S21
,017
21,3
1819
,706
19,6
0419
,502
19,5
0219
,502
19,5
0219
,502
0
*IMPO
RTA
NT
NO
TE:
Leap
yea
r for
mul
as s
houl
d be
cha
nged
by
appl
ican
t to
refle
ct 3
66 d
ays
per y
ear.
Indi
cate
CY
or F
Y
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. I
ndic
ate
on th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
For
sect
ions
4 &
5, t
he n
umbe
r of b
eds
and
occu
panc
y pe
rcen
tage
sho
uld
be re
porte
d on
the
basi
s of
lice
nsed
bed
s. In
an
atta
chm
ent t
o th
e ap
plic
atio
n, p
rovi
de a
n ex
plan
atio
n or
bas
is
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
App
lican
ts m
ust e
xpla
in w
hy th
e as
sum
ptio
ns a
re re
ason
able
.
Indi
cate
CY
or F
Y
Gro
ss P
atie
nt S
ervi
ce R
even
ues
19,3
94,1
53$
20
,177
,089
$
19,0
41,6
87$
17
,141
,149
$
15,2
40,6
10$
14
,460
,646
$
13,3
15,9
22$
12
,951
,162
$
12,9
51,1
62$
-
$
Net
Pat
ient
Ser
vice
s R
even
ue
14,9
29,7
00$
16
,011
,766
$
14,6
09,7
40$
13
,355
,215
$
12,1
00,6
89$
11
,481
,415
$
10,5
72,5
32$
10
,282
,920
$
10,2
82,9
20$
-
$
NET
OPE
RA
TIN
G R
EVEN
UE
15,1
47,8
2 9$
16
,190
,659
$
16,3
29,1
61$
14
,367
,916
$
12,4
06,6
70$
11
,787
,396
$
10,8
78,5
13$
10
,588
,901
$
10,5
88,9
01$
-
$
TO
TAL
OPE
RA
TIN
G E
XPEN
SES
SU
BTO
TAL
(681
,428
)$
(6
89,5
77)
$
56
,399
$
96
3,39
0$
59
2,47
6$
14
,265
$
(1
,876
,593
)$
(2,6
75,1
92)
$
(2
,639
,198
)$
-
$
NET
INC
OM
E (L
OSS
)(6
81,4
28)
$
(689
,577
)$
56,3
99$
963,
390
$
592,
476
$
14,2
65$
(1,8
76,5
93)
$
(2
,675
,192
)$
(2,6
39,1
98)
$
-$
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. T
able
G s
houl
d re
flect
cur
rent
dol
lars
(no
infla
tion)
. Pro
ject
ed re
venu
es a
nd e
xpen
ses
shou
ld b
e co
nsis
tent
with
the
proj
ectio
ns in
Tab
le F
and
with
the
cost
s of
Man
pow
er li
sted
in T
able
L. M
anpo
wer
. Ind
icat
e on
the
tabl
e if
the
repo
rting
per
iod
is C
alen
dar Y
ear (
CY
) or F
isca
l Yea
r (FY
). In
an
atta
chm
ent t
o th
e ap
plic
atio
n,
prov
ide
an e
xpla
natio
n or
bas
is fo
r the
pro
ject
ions
and
spe
cify
all
assu
mpt
ions
use
d. A
pplic
ants
mus
t exp
lain
why
the
assu
mpt
ions
are
reas
onab
le. S
peci
fy th
e so
urce
s of
non
-ope
ratin
g in
com
e.
Indi
cate
CY
or F
Y
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. T
able
G s
houl
d re
flect
cur
rent
dol
lars
(no
infla
tion)
. Pro
ject
ed re
venu
es a
nd e
xpen
ses
shou
ld b
e co
nsis
tent
with
the
proj
ectio
ns in
Tab
le F
and
with
the
cost
s of
Man
pow
er li
sted
in T
able
L. M
anpo
wer
. Ind
icat
e on
the
tabl
e if
the
repo
rting
per
iod
is C
alen
dar Y
ear (
CY
) or F
isca
l Yea
r (FY
). In
an
atta
chm
ent t
o th
e ap
plic
atio
n,
prov
ide
an e
xpla
natio
n or
bas
is fo
r the
pro
ject
ions
and
spe
cify
all
assu
mpt
ions
use
d. A
pplic
ants
mus
t exp
lain
why
the
assu
mpt
ions
are
reas
onab
le. S
peci
fy th
e so
urce
s of
non
-ope
ratin
g in
com
e.
TOTA
L 10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
0.0%
TOTA
L 10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
0.0%
Gro
ss P
atie
nt S
ervi
ce R
even
ues
19,3
94,1
53$
20
,177
,089
$
19,0
41,6
87$
17
,141
,149
$
15,4
31,1
18$
14
,631
,655
$
13,4
77,8
12$
13
,113
,052
$
13,4
40,8
78$
-
$
Net
Pat
ient
Ser
vice
s R
even
ue
14,9
29,7
00$
16
,011
,766
$
14,6
09,7
40$
13
,355
,215
$
12,2
51,9
48$
11
,617
,192
$
10,7
01,0
68$
10
,411
,457
$
10,6
71,7
43$
-
$
NET
OPE
RA
TIN
G R
EVEN
UE
15,1
47,8
29$
16
,190
,659
$
16,3
29,1
61$
14
,367
,916
$
12,5
57,9
29$
11
,923
,173
$
11,0
07,0
49$
10
,717
,438
$
10,9
77,7
24$
-
$
TO
TAL
OPE
RA
TIN
G E
XPEN
SES
SU
BTO
TAL
(681
,428
)$
(689
,577
)$
56,3
99$
78
8,47
8$
52
1,58
7$
(2
99,3
02)
$
(2
,429
,753
)$
(3
,465
,983
)$
(3
,412
,736
)$
-
$
NET
INC
OM
E (L
OSS
) (6
81,4
28)
$
(6
89,5
77)
$
56
,399
$
788,
478
$
521,
587
$
(299
,302
)$
(2,4
29,7
53)
$
(3,4
65,9
83)
$
(3,4
12,7
36)
$
-$
TOTA
L10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
0.0%
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. T
able
H s
houl
d re
flect
infla
tion.
Pro
ject
ed re
venu
es a
nd e
xpen
ses
shou
ld b
e co
nsis
tent
with
the
proj
ectio
ns in
Tab
le F
. In
dica
te o
n th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
In a
n at
tach
men
t to
the
appl
icat
ion,
pro
vide
an
expl
anat
ion
or b
asis
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
A
pplic
ants
mus
t exp
lain
why
the
assu
mpt
ions
are
reas
onab
le.
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. T
able
H s
houl
d re
flect
infla
tion.
Pro
ject
ed re
venu
es a
nd e
xpen
ses
shou
ld b
e co
nsis
tent
with
the
proj
ectio
ns in
Tab
le F
. In
dica
te o
n th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
In a
n at
tach
men
t to
the
appl
icat
ion,
pro
vide
an
expl
anat
ion
or b
asis
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
A
pplic
ants
mus
t exp
lain
why
the
assu
mpt
ions
are
reas
onab
le.
TOTA
L 10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
0.0%
Tota
l MSG
A
Tota
l MSG
A
Tota
l Acu
te0
00
00
00
TOTA
L D
ISC
HA
RG
ES0
00
00
00
Tota
l MSG
A
Tota
l Acu
te0
00
00
00
TOTA
L PA
TIEN
T D
AYS
00
00
00
0
Tota
l MSG
A
Tota
l Acu
te
TOTA
L A
VER
AG
E LE
NG
TH O
F ST
AY
INS
TRU
CTI
ON
: Afte
r con
sulti
ng w
ith C
omm
issi
on S
taff,
com
plet
e th
is ta
ble
for t
he n
ew fa
cilit
y or
ser
vice
(the
pro
pose
d pr
ojec
t). In
dica
te o
n th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
For s
ectio
ns 4
& 5
, the
nu
mbe
r of b
eds
and
occu
panc
y pe
rcen
tage
sho
uld
be re
porte
d on
the
basi
s of
lice
nsed
bed
s. In
an
atta
chm
ent t
o th
e ap
plic
atio
n, p
rovi
de a
n ex
plan
atio
n or
bas
is fo
r the
pro
ject
ions
and
spe
cify
all
assu
mpt
ions
use
d. A
pplic
ants
mus
t ex
plai
n w
hy th
e as
sum
ptio
ns a
re re
ason
able
.
INS
TRU
CTI
ON
: Afte
r con
sulti
ng w
ith C
omm
issi
on S
taff,
com
plet
e th
is ta
ble
for t
he n
ew fa
cilit
y or
ser
vice
(the
pro
pose
d pr
ojec
t). In
dica
te o
n th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
For s
ectio
ns 4
& 5
, the
nu
mbe
r of b
eds
and
occu
panc
y pe
rcen
tage
sho
uld
be re
porte
d on
the
basi
s of
lice
nsed
bed
s. In
an
atta
chm
ent t
o th
e ap
plic
atio
n, p
rovi
de a
n ex
plan
atio
n or
bas
is fo
r the
pro
ject
ions
and
spe
cify
all
assu
mpt
ions
use
d. A
pplic
ants
mus
t ex
plai
n w
hy th
e as
sum
ptio
ns a
re re
ason
able
.
Tota
l MSG
A
Tota
l Acu
te0
00
00
00
TOTA
L LI
CEN
SED
BED
S0
00
00
Tota
l MSG
A
Tota
l Acu
t e
TOTA
L O
CC
UPA
NC
Y %
TOTA
L O
UTP
ATI
ENT
VISI
TS9,
751
19,5
0219
,502
19,5
0219
,502
19,5
020
*IM
POR
TAN
T N
OTE
: Le
ap y
ear f
orm
ulas
sho
uld
be c
hang
ed b
y ap
plic
ant t
o re
flect
366
day
s pe
r yea
r.
Gro
ss P
atie
nt S
ervi
ce R
even
ues
7,62
0,30
5$
15,2
40,6
10$
14
,460
,646
$
13,3
15,9
22$
12
,951
,162
$
12,9
51,1
62$
-
$
Net
Pat
ient
Ser
vice
s R
even
ue
6,05
0,34
4$
12,1
00,6
89$
11
,481
,415
$
10,5
72,5
32$
10
,282
,920
$
10,2
82,9
20$
-
$
NET
OPE
RA
TIN
G R
EVEN
UE
6,20
3,33
5$
12,4
06,6
70$
11
,787
,396
$
10,8
78,5
13$
10
,588
,901
$
10,5
88,9
01$
-
$
TO
TAL
OPE
RA
TIN
G E
XPEN
SES
SU
BTO
TAL
899,
456
$
556,
357
$
(28,
306)
$
(1,8
65,3
43)
$
(2,6
64,5
59)
$
(2,6
29,4
98)
$
-$
NET
INC
OM
E (L
OSS
)89
9,45
6$
55
6,35
7$
(2
8,30
6)$
(1
,865
,343
)$
(2
,664
,559
)$
(2
,629
,498
)$
-
$
INS
TRU
CTI
ON
: Afte
r con
sulti
ng w
ith C
omm
issi
on S
taff,
com
plet
e th
is ta
ble
for t
he n
ew fa
cilit
y or
ser
vice
(the
pro
pose
d pr
ojec
t). T
able
J s
houl
d re
flect
cur
rent
do
llars
(no
infla
tion)
. Pro
ject
ed re
venu
es a
nd e
xpen
ses
shou
ld b
e co
nsis
tent
with
the
proj
ectio
ns in
Tab
le I
and
with
the
cost
s of
Man
pow
er li
sted
in T
able
L.
Man
pow
er. I
ndic
ate
on th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
In a
n at
tach
men
t to
the
appl
icat
ion,
pro
vide
an
expl
anat
ion
or
basi
s fo
r the
pro
ject
ions
and
spe
cify
all
assu
mpt
ions
use
d. A
pplic
ants
mus
t exp
lain
why
the
assu
mpt
ions
are
reas
onab
le. S
peci
fy th
e so
urce
s of
non
-ope
ratin
g in
com
e.
INS
TRU
CTI
ON
: Afte
r con
sulti
ng w
ith C
omm
issi
on S
taff,
com
plet
e th
is ta
ble
for t
he n
ew fa
cilit
y or
ser
vice
(the
pro
pose
d pr
ojec
t). T
able
J s
houl
d re
flect
cur
rent
do
llars
(no
infla
tion)
. Pro
ject
ed re
venu
es a
nd e
xpen
ses
shou
ld b
e co
nsis
tent
with
the
proj
ectio
ns in
Tab
le I
and
with
the
cost
s of
Man
pow
er li
sted
in T
able
L.
Man
pow
er. I
ndic
ate
on th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
In a
n at
tach
men
t to
the
appl
icat
ion,
pro
vide
an
expl
anat
ion
or
basi
s fo
r the
pro
ject
ions
and
spe
cify
all
assu
mpt
ions
use
d. A
pplic
ants
mus
t exp
lain
why
the
assu
mpt
ions
are
reas
onab
le. S
peci
fy th
e so
urce
s of
non
-ope
ratin
g in
com
e.
TOTA
L 10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%0.
0%
TOTA
L 10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%0.
0%
Tota
l MSG
A
Gro
ss P
atie
nt S
ervi
ce R
even
ues
7,62
0,30
5$
15,4
31,1
18$
14,6
31,6
55$
13,4
77,8
12$
13,1
13,0
52$
13,4
40,8
78$
-$
Net
Pat
ient
Ser
vice
s R
even
ue
6,05
0,34
4$
12,2
51,9
48$
11,6
17,1
92$
10,7
01,0
68$
10,4
11,4
57$
10,6
71,7
43$
-$
NET
OPE
RA
TIN
G R
EVEN
UE
6,20
3,33
5$
12,5
57,9
29$
11,9
23,1
73$
11,0
07,0
49$
10,7
17,4
38$
10,9
77,7
24$
-$
TO
TAL
OPE
RA
TIN
G E
XPEN
SES
SU
BTO
TAL
899,
456
$
485,
468
$
(341
,873
)$
(2
,418
,503
)$
(3,4
55,3
50)
$
(3
,403
,036
)$
-$
NET
INC
OM
E (L
OSS
)89
9,45
6$
48
5,46
8$
(3
41,8
73)
$
(2,4
18,5
03)
$
(3
,455
,350
)$
(3,4
03,0
36)
$
-
$
INS
TRU
CTI
ON
: Afte
r con
sulti
ng w
ith C
omm
issi
on S
taff,
com
plet
e th
is ta
ble
for t
he n
ew fa
cilit
y or
ser
vice
(the
pro
pose
d pr
ojec
t). T
able
K s
houl
d re
flect
infla
tion.
Pro
ject
ed
reve
nues
and
exp
ense
s sh
ould
be
cons
iste
nt w
ith th
e pr
ojec
tions
in T
able
I. In
dica
te o
n th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
In a
n at
tach
men
t to
the
appl
icat
ion,
pro
vide
an
expl
anat
ion
or b
asis
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
App
lican
ts m
ust e
xpla
in w
hy th
e as
sum
ptio
ns a
re
reas
onab
le.
INS
TRU
CTI
ON
: Afte
r con
sulti
ng w
ith C
omm
issi
on S
taff,
com
plet
e th
is ta
ble
for t
he n
ew fa
cilit
y or
ser
vice
(the
pro
pose
d pr
ojec
t). T
able
K s
houl
d re
flect
infla
tion.
Pro
ject
ed
reve
nues
and
exp
ense
s sh
ould
be
cons
iste
nt w
ith th
e pr
ojec
tions
in T
able
I. In
dica
te o
n th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
In a
n at
tach
men
t to
the
appl
icat
ion,
pro
vide
an
expl
anat
ion
or b
asis
for t
he p
roje
ctio
ns a
nd s
peci
fy a
ll as
sum
ptio
ns u
sed.
App
lican
ts m
ust e
xpla
in w
hy th
e as
sum
ptio
ns a
re
reas
onab
le.
TOTA
L 10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%0.
0%
TOTA
L 10
0.0%
100.
0%10
0.0%
100.
0%10
0.0%
100.
0%0.
0%
(sho
uld
be
cons
iste
ntw
ithpr
ojec
tions
in
Tabl
e G
, if
(sho
uld
be
cons
iste
nt w
ith
proj
ectio
ns in
Ta
ble
G)
(Lis
t gen
eral
ca
tego
ries,
add
row
s if
need
ed)
(Lis
t gen
eral
ca
tego
ries,
add
row
s if
need
ed)
(Lis
t gen
eral
ca
tego
ries,
add
row
s if
need
ed)
REG
ULA
R E
MPL
OYE
ES T
OTA
L12
0.2
$57,
254
6,88
2,47
8-3
9.6
$69,
779
-2,7
66,0
20
(Lis
t gen
eral
ca
tego
ries,
add
row
s if
need
ed)
(Lis
t gen
eral
ca
tego
ries,
add
row
s if
need
ed)
(Lis
t gen
eral
ca
tego
ries,
add
row
s if
need
ed)
CO
NTR
AC
TUA
L EM
PLO
YEES
TO
TAL
(Sta
te m
etho
d of
ca
lcul
atin
g be
nefit
s be
low
):
TOTA
L C
OST
120.
2$8
,460
,104
-39.
6-$
3,36
4,73
40.
0$0
$5,0
95,3
70
INS
TRU
CTI
ON
: Lis
t the
faci
lity'
s ex
istin
g st
affin
g an
d ch
ange
s re
quire
d by
this
pro
ject
. Inc
lude
all
maj
or jo
b ca
tego
ries
unde
r eac
h he
adin
g pr
ovid
ed in
the
tabl
e. T
he n
umbe
r of F
ull T
ime
Equ
ival
ents
(FTE
s) s
houl
d be
cal
cula
ted
on th
e ba
sis
of 2
,080
pai
d ho
urs
per y
ear e
qual
s on
e FT
E. I
n an
atta
chm
ent t
o th
e ap
plic
atio
n, e
xpla
in a
ny fa
ctor
use
d in
con
verti
ng p
aid
hour
s to
wor
ked
hour
s. P
leas
e en
sure
that
the
proj
ectio
ns in
th
is ta
ble
are
cons
iste
nt w
ith e
xpen
ses
prov
ided
in u
ninf
late
d pr
ojec
tions
in T
able
s F
and
G.
CU
RR
ENT
ENTI
RE
FAC
ILIT
Y
PRO
JEC
TED
CH
AN
GES
AS
A R
ESU
LT O
FTH
E PR
OPO
SED
PR
OJE
CT
THR
OU
GH
TH
E LA
ST Y
EAR
OF
PRO
JEC
TIO
N
(CU
RR
ENT
DO
LLA
RS)
OTH
ER E
XPEC
TED
CH
AN
GES
IN
OPE
RA
TIO
NS
THR
OU
GH
TH
E LA
ST
YEA
R O
F PR
OJE
CTI
ON
(CU
RR
ENT
DO
LLA
RS)
PRO
JEC
TED
EN
TIR
E FA
CIL
ITY
THR
OU
GH
TH
E LA
ST Y
EAR
OF
PRO
JEC
TIO
N (C
UR
REN
T
Indi
cate
CY
or F
Y
Tota
l MSG
A
Tota
l Acu
te17
,253
17,2
1415
,700
15,7
3615
,736
15,7
3615
,736
15,7
3615
,736
0
TOTA
L D
ISC
HA
RG
ES17
,253
17,2
1415
,700
15,7
3615
,736
15,7
3615
,736
15,7
3615
,736
0
Tota
l MSG
A
Tota
l Acu
te75
,562
74,6
8468
,450
68,6
1068
,610
68,6
1068
,610
68,6
1068
,610
0
TOTA
L PA
TIEN
T D
AYS
75,5
6274
,684
68,4
5068
,610
68,6
1068
,610
68,6
1068
,610
68,6
100
Tota
l MSG
A
Tota
l Acu
te
TOTA
LA
VER
AG
ELE
NG
THO
FST
AY
INS
TRU
CTI
ON
: Com
plet
e th
is ta
ble
for t
he e
ntire
faci
lity,
incl
udin
g th
e pr
opos
ed p
roje
ct. I
ndic
ate
on th
e ta
ble
if th
e re
porti
ng p
erio
d is
Cal
enda
r Yea
r (C
Y) o
r Fis
cal Y
ear (
FY).
For
sect
ions
4 &
5, t
he n
umbe
r of b
eds
and
occu
panc
y pe
rcen
tage
sho
uld
be re
porte
d on
the
basi
s of
lice
nsed
bed
s. In
an
atta
chm
ent t
o th
e ap
plic
atio
n, p
rovi
de a
n ex
plan
atio
n or
bas
is fo
r th
e pr
ojec
tions
and
spe
cify
all
assu
mpt
ions
use
d. A
pplic
ants
mus
t exp
lain
why
the
assu
mpt
ions
are
reas
onab
le.
Tota
l MSG
A
Tota
l Acu
te28
128
928
826
626
626
626
626
626
60
TOTA
L LI
CEN
SED
BED
S28
128
928
826
626
626
626
626
626
60
Tota
l MSG
A
Tota
l Acu
te
TOTA
L O
CC
UPA
NC
Y %
TOTA
L O
UTP
ATI
ENT
VISI
TS56
2,60
856
4,53
261
3,56
067
2,63
467
2,63
467
2,63
467
2,63
467
2,63
467
2,63
40
*IMPO
RTA
NT
NO
TE:
Leap
yea
r for
mul
as s
houl
d be
cha
nged
by
appl
ican
t to
refle
ct 3
66 d
ays
per y
ear.
Indi
cate
CY
or F
Y
Gro
ss P
atie
nt S
ervi
ce R
even
ues
520,
943,
486
$
54
8,73
1,22
8$
573,
888,
024
$
62
2,72
1,79
3$
624,
001,
820
$
62
5,07
0,56
5$
626,
443,
416
$
62
7,82
0,38
6$
629,
201,
487
$
-
$
Net
Pat
ient
Ser
vice
s R
even
ue
409,
068,
059
$
43
1,65
4,00
7$
452,
296,
458
$
47
4,33
4,06
7$
474,
215,
797
$
47
4,74
2,64
5$
475,
785,
328
$
47
6,83
1,14
0$
477,
880,
089
$
-
$
NET
OPE
RA
TIN
G R
EVEN
UE
411,
635,
795
$
43
4,25
8,57
7$
456,
070,
511
$
47
8,39
4,10
6$
478,
275,
836
$
47
8,80
2,68
4$
479,
845,
367
$
48
0,89
1,17
9$
481,
940,
128
$
-
$
187,
488
$
32
9,16
0$
329,
155
$
18
7,48
8$
46,0
00$
46
,000
$
46,0
00$
46
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TIN
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EXHIBIT 3
Peninsula Regional Medical Center Policy/Procedure
Finance Division
Subject:
Affected Areas:
Policy/ProcedureNumber:
Policy:
Procedure:
EXHIBIT 4
ADMINISTRATIVE POLICY MANUAL Subject: Financial Assistance / Uncompensated Care
Effective Date: August 1981Approved by: President/CEO and Vice President of Finance/CFOResponsible Parties: Senior Executive Director of FinanceRevised Date: 12/86, 6/88, 3/90, 3/91, 7/93, 7/94, 8/98, 12/05, 8/08,
5/10, 10/10, 12/14, 7/16, 11/16, 7/17, 7/18, 7/19Reviewed Date: 8/83, 12/85, 2/88, 6/92, 8/95, 7/96, 9/97, 6/00, 6/01,
10/02, 10/04, 12/11, 12/12, 12/13Key Words: Financial Assistance, Federal Poverty Guidelines, Charity Care,
Uncompensated
POLICY
Peninsula Regional Medical Center (PRMC) will provide emergency and medically necessary free and/or reduced-cost care to patients who lack health care coverage or whose health care coverage does not pay the full cost of their hospital bill. For purposes of this policy, PRMC shall include the hospital, medical center, and physician services billed by PRMC, commonly referred to as Peninsula Regional Medical Group (PRMG). A patient’s payment shall not exceed the amount generally billed (AGB). All hospital regulated services (which includes emergency and medically necessary care) will be charged consistently as established by the Health Services Cost Review Commission (HSCRC) which equates to the amounts generally billed (AGB) method. All patients seen by a PRMG provider or in an unregulated area will be charged the fee schedule plus the standard mark-up. The AGB for PRMG and other services not regulated by the HSCRC equates to the Medicare fee-for-service amount under the prospective method. A 50% discount will be applied to all self-pay unregulated services and patients seen by a PRMG provider. The 50% discount reduces the patient responsibility to the AGB. If the patient qualifies for financial assistance, this 50% discount will be granted prior to the application of the financial assistance write-off.
PRMC may use outsource vendors to provide patient collection and/or pre-collection services. Vendors act in accordance with PRMC policies and wherever policy notates employee, financial services department, or other such wording – vendor and/or vendor employees are included without such notation.
Definitions:a. Elective Care: Care that can be postponed without harm to the patient or that is
not medically necessary. An appropriate clinical or physician representative will be contacted for consultation in determining the patient status.
b. Medical Necessity: Any procedure reasonably determined to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause suffering or pain, resulting in illness or infirmity, threatening to cause or aggravate a handicap, or cause physical deformity or malfunction, if there is no other equally effective, more conservative or less costly course of treatment available.
c. Immediate Family: A family unit is defined to include all individuals taken as exemptions on the income tax return for the individual completing the application, whether or not they were the individual filing the return or listed as a spouse or dependent. For homeless persons or in the event that a family member is not obtainable, the family unit size will be assumed to be one. If a tax return has not
Financial Assistance / Uncompensated Care 2
been filed, then income from all members living in the household will be considered.
d. Liquid Assets: Cash, checking/savings account balances, certificates of deposit, stocks, bonds, money market funds, rental properties etc. The availability of liquid assets plus annual income may be considered in relation to the current poverty guidelines published in the Federal Register.
e. Medical Debt: Out of pocket expenses, excluding copayments, coinsurance and deductibles, for medical costs for medical costs billed by PRMC.
f. Extraordinary Collection Actions (ECA): Any legal action and/or reporting the debt to a consumer reporting agency.
PRMC will provide free medically necessary care to patients with family income at or below 200% of the federal poverty level. Patients qualifying for financial assistance based on income at or below 200% of the federal poverty level have no cost for their care and therefore pay less than AGB.
PRMC will provide reduced-cost medically necessary care to low-income patients with family income between 200% and 300% of the Federal poverty level.
PRMC will provide reduced-cost medically necessary care to low-income patients with family income between 301% and 500% of the Federal poverty level who have a medical hardship as defined by Maryland Law. Medical hardship is medical debt, incurred by a family over a 12 month period that exceeds 25% of the family income.
Other healthcare fees and professional fees that are not provided by PRMC/PRMG are not included in this policy. Pre-planned service may only be considered for financial assistance when the service is medically necessary. As an example, cosmetic surgery is excluded. Inpatient, outpatient, emergency services, and services rendered by PRMG are eligible.
PRMC’s financial assistance is provided only to bills related to services provided at PRMC or at a PRMC site including services provided by physicians employed by PRMC. These services are generally referred to as PRMG. To determine if your physician services are covered by the PRMC financial assistance program, please see the roster of providers that deliver emergency and other medically necessary care, indicating which providers are covered under the policy and which are not. The list of providers is updated quarterly and available on the medical center website. If you prefer, you may contact any financial counselor or patient accounting representative by calling (410) 912-4974, or in person at the hospital.
PROCEDURE
If a patient is unable to pay due to financial resources, all efforts will be made to help the patient obtain assistance through appropriate agencies. In the event that the patient has applied for and kept all necessary appointments and third party assistance is not available, PRMC will provide care at reduced or zero cost. When no third party assistance is available to cover the total bill and the patient indicates that they have insufficient funds, Financial Assistance (FA) will be offered. The Maryland State Uniform Financial Assistance application,Financial Assistance Policy, Patient Collection Practice Policy, and plain language summary, can be obtained by one of the following ways:
a. Available free of charge and upon request by calling (410) 543-7436 or(877) 729-7762.
b. Are located in the registration areas.c. Downloaded from the hospital website:
https://www.peninsula.org/patients-visitors/patient-formshttps://www.peninsula.org/patients-visitors/patient-billing-information
d. The plain language summary is inserted in the Admission packet and with all patient statements.
Financial Assistance / Uncompensated Care 3
e. Through signs posted in the main registration areas.f. Annual notification in the local newspaper.g. The application is available in English and Spanish. No other language constitutes
a group that is 5% or more, or more than 1,000 residents (whichever is less) of the population in our primary service area (Worcester, Wicomico and Somerset Counties) based on U.S. Census data.
h. For patients who have difficulty in filling out an application, the information can be taken orally by calling (410) 912-6957 or in person at the Financial Counselor’sOffice located in the Frank B. Hanna Outpatient Center.
The patient’s income will be compared to current Federal Poverty Guidelines (on file with the Collection Coordinator). The Collection Coordinator representative will consult with the patient as needed to make assessment of eligibility.
a. If the application is received within 240 days of the first post-discharge billing statement, and the account is with a collection agency, the agency will be notified to suspend all Extraordinary Collection Actions (ECA) until the application and all appeal rights have been processed.
b. If the application is incomplete, all ECA efforts will remain on hold for a reasonable amount of time and assistance will be provided to the patient in order to get the application completed. If there is not a phone contact to call, a written notice that describes the additional information and/or documentation required will be mailed which includes a phone contact to call for assistance.
c. Preliminary eligibility will be made within 2 business days based upon receipt of sufficient information to determine probably eligibility. A letter will be mailed to patients notifying them of their eligibility status. Following preliminary approval, patients must submit a completed application and any supporting documentation requested (if not done previously). Upon final approval, a financial assistance discount will be applied to the patient’s responsibility.
d. Patients who are beneficiaries/recipients of certain means-tested social services programs are deemed to have presumptive eligibility at 100% and are FA eligible without the completion of an application or submission of supporting documentation. It is the responsibility of the patient to notify the hospital that they are in a means-tested program. This information may also be obtained from an outsourced vendor or other means available to PRMC.
e. A patient that has qualified for Maryland Medical Assistance is deemed to automatically qualify for Financial Assistance (FA) at 100%. The amount due from a patient on these accounts may be written off to FA with verification of Medicaid eligibility. Standard documentation requirements are waived.
f. The hospital may automatically approve Financial Assistance for accounts ready to be sent to a collection agency that are identified as Poverty based on the propensity to pay score.
g. If the application is ineligible, normal dunning processes will resume, which includes notifying the agency if applicable to proceed with ECA efforts. A copy of the Medical Center Collections Policy may be obtained by calling (410) 543-7436or (877) 729-7762 and is available on the website listed above.
h. The patient may request reconsideration by submitting a letter to the Director of Patient Financial Services indicating the reason for the request.
Financial Assistance / Uncompensated Care 4
i. Only income and family size will be considered in approving applications for FA unless one of the following three scenarios occurs:
The amount requested is greater than $50,000The tax return shows a significant amount of interest income, or the patient states they have been living off of their savings accountsDocumentation indicates significant wealth
j. If one of the above three scenarios are applicable, liquid assets may be considered including:
Checking and savings accountsStocks and bondsCD’sMoney market or any other financial accounts for the past three monthsLast year’s tax returnA credit report may also be reviewed
The following assets are excluded:The first $10,000 of monetary assetsUp to $150,000 in a primary residenceCertain retirement benefits such as a 401-K where the IRS has granted preferential tax treatment as a retirement account including but not limited to deferred-compensation plans qualified under the Internal Revenue Code, or nonqualified deferred-compensation plans where the patient potentially could be required to pay taxes and/or penalties by cashing in the benefit.
If the balance due is sufficient to warrant it and the assets are suitable, a lien may be placed on the assets for the amount of the bill. Collection efforts will consist of placement of the lien which will result in payment to the hospital upon sale or transfer of the asset. Refer to the Medical Center Collection policy on filing liens.
k. If the hospital has reason to believe the information is unreliable or incorrect, or obtained under duress, or through the use of coercive practices, FA may be denied.
l. We do not request or provide waivers, written or oral, expressing patient does not wish to apply for assistance.
Collection Coordinator
a. If eligible, and under $2,500, the account will be written off to FA when the “Request for Financial Assistance” form is finalized. A copy is retained in the patient’s electronic file. If eligible, and the balance is $2,500 or above, the Collection Coordinator will obtain the appropriate adjustment signature(s).
b. PRMC will review only those accounts where the patient or guarantor inquire about FA, based on mailing in an application, or in the normal working of the account there is indication that the patient may be eligible. Any patient/customer service representative, financial counselor, or collection representative may begin the application process.
c. Once a request has been approved, service eight months before the approval and twelve months after the approval may be included in the adjustment. All encounters included with the application must reference the original encounter number where the electronic image of the application is stored. Service dates outside this twenty month window may be included if approved by a Supervisor, Manager, or Director. Any amount exceeding $5 that has already been collected from the patient or guarantor for approved dates of service shall be refunded to the patient if the determination is made within two years of the date of care.
Financial Assistance / Uncompensated Care 5
d. PRMC will communicate with the patient using the method preferred by the patient including electronic communications, telephone or mail.
______________________ ________________________Steven Leonard Bruce RitchiePresident/CEO Vice President of Finance/CFO
Financial Assistance / Uncompensated Care 6
PLAIN LANGUAGE SUMMARY
Financial Assistance PolicyIt is the intention of Peninsula Regional Medical Center (PRMC) to make available to all patients the highest quality of medical care possible within the resources available. If a patient is unable to pay due to financial resources, all efforts will be made to help the patient obtain assistance through appropriate agencies, or, if no help is available, to render care at a reduced or zero cost for emergency and medically necessary care.
Patients requiring elective services may, through consultation with their physician, have their procedure postponed until such time as the patient is able to make full payment or meet the established deposit. Elective procedure patients who, according to their diagnosis and/or their physician, cannot have their procedure postponed will be helped with obtaining assistance from agencies. If no assistance is available, and the patient requests, the account will be reviewed for possible financial assistance.
Peninsula Regional Medical Group (PRMG) physician charges are not included in the hospital bill and are billed separately, with the exception of self-pay balances. Self-pay balances for hospital services and PRMG services will appear on the same statement. Physician charges outside of the PRMG group are not included in the hospital bill and will be billed separately. Physician charges outside of PRMG are not covered by Peninsula Regional Medical Center’s financial assistance policy. A list of providers that deliver emergency and other medically necessary care at PRMC is provided on the website at www.peninsula.org/prmg, indicating which providers are covered under PRMC’s financial assistance policy and which are not, oryou may call (410) 912-4974.
In the event that the patient has applied for and kept all necessary appointments and third party assistance is not available, the patient may be eligible for financial assistance.
Eligibility Determination Process1. Interview patient and/or family.2. Obtain annual gross income.3. Determine eligibility (preliminary eligibility within 2 business days).4. Screen for possible referral to external charitable programs.5. If the patient and/or family refuse to disclose financial resources or cooperate, the patient
will be subject to standard collection efforts. No Extraordinary Collection Actions (ECA) will be taken for at least 120 days from the first post-discharge billing statement.
6. All applications received within 240 days of the first post-discharge billing statement will be reviewed. ECA actions will be suspended until the application has been processed.
7. The determination of eligibility (approval or denial) shall be made in a timely manner.
How to ApplyApplications can be taken orally by calling (410) 912-6957 between 8:00 a.m. and 5:00 p.m., Monday through FridayIn person at the Financial Counselor’s office (located in the Frank B. Hanna Outpatient Center lobby) between 8:00 a.m. and 4:00 p.m., Monday through FridayMailing a request for an application to Peninsula Regional Medical Center, PO Box 2498, Salisbury, MD 21802-2498On the internet at https://www.peninsula.org/patients-visitors/patient-forms or
https://www.peninsula.org/patients-visitors/patient-billing-informationApplications are available in English and in Spanish
Financial Assistance / Uncompensated Care 7
QualificationsPeninsula Regional Medical Center compares the patient’s income to the Federal Poverty Guidelines. In order to process your application we require the following information:
An independent third party to verify your household income (one of the following)a. Recent pay stub showing current and year-to-date earningsb. Most recent tax return showing your Adjusted Gross Income or W-2 formc. Written documentation of Social Security benefits, SSI disability, VA benefits, etc.d. If no income, a letter from an independent source such as a clergy or neighbor
verifying no incomeCompleted application
This information, and any information obtained from external sources, is used to determine your eligibility for financial assistance. The more information provided, the easier it is for us to determine your financial need. Peninsula Regional may request a credit report to support a patient’s application for assistance.
Need Assistance?If, at any time, you have questions about obtaining financial assistance, your hospital bill, your rights and obligations with regard to the bill, or applying for the Medical Assistance Program, please contact Peninsula Regional Medical Center’s Financial Services Department at (410) 912-6957 or (877) 729-7762. You can obtain a copy of the PRMC Financial Assistance Policy at https://www.peninsula.org/patients-visitors/patient-billing-information /financial-assistance-documents.
Medical Assistance ProgramTo find out if you are eligible for Maryland Medical Assistance or other public assistance, please apply at your local Department of Social Services (DSS) office, or you may visit mmcp.dhmh.maryland.gov for information about the various Medicaid programs available. You may apply online for Maryland Medicaid at marylandhealthconnection.gov. If you are applying for assistance for a child or are pregnant, you may apply for the Maryland Children’s Health Program (MCHP). If you are only applying for assistance with paying your Medicare premiums, co-payments, or deductibles, you may apply at your local Department of Social Services (DSS) for the Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) Program. QMB/SLMB applications may be filed by mail or in person. Delaware residents may obtain information online at dhss.delaware.gov or apply online at assist.dhss.delaware.gov. Virginia residents may obtain information at dmas.Virginia.gov. To receive an application, call your local DSS office or the Area Agency on Aging, (AAA). For more information, you may call the Department of Health and Mental Hygiene’s Recipient Relations Hotline at 1 (800) 492-5231 or (410) 767-5800.
Patients’ Rights and ObligationsRights:
Prompt notification of their preliminary eligibility determination for financial assistance.Guidance from Peninsula Regional on how to apply for financial assistance and other programs which may help them with the payment of their hospital bill.Receipt of financial assistance for all services not payable by another program that meet the qualifications of Peninsula Regional’s Financial Assistance Policy.Peninsula Regional Medical Center (PRMC) will provide emergency and medically necessary free and/or reduced-cost care to patients who lack health care coverage or whose health care coverage does not pay the full cost of their hospital bill.
Financial Assistance / Uncompensated Care 8
Obligations:Submit complete and accurate information on the Uniform Financial Assistance Application in use in the state of Maryland.Attach supporting documentation and return the form to Peninsula Regional Medical Center in a timely manner.Make payment in full or establish a payment plan for services not qualified under Peninsula Regional’s Financial Assistance Policy.
Cómo hacer la solicitudLlame al (410) 912-6957 o (877) 729-7762 entre las 8:00 a.m. y las 5:00 p.m., de lunes a viernesAcuda en persona a la oficina del consejero financiero (Localizado en el vestibulo Frank B. Hanna del Centro de attencion de Pacientes Externos) entre las 8:00 a.m. y las 4:00 p.m., de lunes a viernes A través de Internet, visite www.peninsula.org. Haga clic en Patients & Visitors (Pacientes y vistantes), luego en Patient Financial Services (Servicios financieros para pacientes) y después en Billing Information (Información de facturación)
MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION
Information About You Name: _____________________________________________________________________ First Middle Last Social Security Number _______-____-_____ Marital Status: Single Married Separated US Citizen Yes No Permanent Resident: Yes No Home Address _________________________________________________ _________________________________________________ _________________________________________________ _____________________ City State Zip Code Country Employer Name ________________________________________________ Phone ________________ Work Address ________________________________________________ ________________________________________________ City State Zip Code Household Members: ____________________________________ _______ ___________________________________ Name Age Relationship ____________________________________ _______ ___________________________________ Name Age Relationship ____________________________________ _______ ___________________________________ Name Age Relationship ____________________________________ _______ ___________________________________ Name Age Relationship ____________________________________ _______ ___________________________________ Name Age Relationship ____________________________________ _______ ___________________________________ Name Age Relationship ____________________________________ _______ ___________________________________ Name Age Relationship ____________________________________ _______ ___________________________________ Name Age Relationship Have you applied for Medical Assistance ? Yes No If yes, what was the date you applied? ___________________ If yes, what was the determination _____________________________________________________________ Do you receive any state or County Assistance? Yes No
PRMC – Patient Accounts 100 East Carroll Street Salisbury, MD 21801
PA-059 (12/05)
II. Family Income List the amount of your monthly income from all sources. You may be required to supply proof of income, assets, and expenses. If you have no income, please provide a letter of support from the person providing your housing and meals. Monthly Amount Employment ____________________ Retirement/Pension Benefits ___________________ Social Security Benefits ___________________ Public Assistance Benefits ___________________ Disability Benefits ___________________ Unemployment Benefits ___________________ Veterans Benefits ___________________ Alimony ___________________ Rental Property Income ___________________ Strike Benefits ___________________ Military Allotment ___________________ Farm or Self-Employment ___________________ Other Income Source ___________________ Total ___________________ II. Liquid Assets Current Balance Checking Account ____________________ Savings Account ____________________ Stocks, Bonds, CD, or Money Market ____________________ Other Accounts ____________________ TTotal ___________________ III. Other Assets If you own any of the following items, please list the type and approximate value. Home Loan Balance ______________________ Approximate Value____________________ Automobile Make _______________ Year_________ Approximate Value____________________ Additional Vehicle Make _______________ Year_________ Approximate Value____________________ Additional Vehicle Make _______________ Year_________ Approximate Value___________________ Other Property Approximate Value____________________ TTotal ___________________
IV. Monthly Expense Amount Rent or Mortgage ____________________ Utilities ____________________ Car Payment(s) ____________________ Credit Card(s) ____________________ Car Insurance ____________________ Health Insurance ____________________ Other Medical Expenses ____________________ Other Expenses ____________________ TTotal ___________________ Do you have any other unpaid medical Bills? Yes No For what service? _________________________________________ If you have arranged a payment plan, what is the monthly payment? _______________________________ If you request that the hospital extend additional financial assistance, the hospital may request additional information in order to make supplemental determination. By signing this form, you certify that the information provided is true and agree to notify the hospital of any changes to the information provided within 10 days.
Applicant Signature _____________________________________________ Date _______________________
Relationship to Patient ___________________________________________
PA-059 (12/05)
EXHIBIT 5
Somerset County, Maryland 2017 - 2018
Community Health Needs Assessment
Prepared by:
1
Somerset County Community Health Needs Assessment
Table of Contents
Executive Summary Introduction Study Methodology About Somerset County
Demographics Education Economy Housing and Transportation Crime, Safety, and Disaster Preparedness Other Societal and Geographic Factors
Overview of Community Health Needs in Somerset County Access to Healthcare in Somerset County Healthcare Affordability in Somerset County Nature and Scope of Healthcare Services in the County Healthcare Literacy Behavioral Health, Substance Abuse, and Other Addictions Tobacco Cessation Diet and Obesity Cardio Vascular Diseases Cancer Diabetes Infectious Diseases and Immunization Maternal and Child Health Environmental Health Oral Health SNFs, Extended Care Organizations, and End-of-Life Care Care Giver Needs Conclusions and Recommendations APPENDIX A - Somerset County Community Health Needs Dashboard
2
EXECUTIVE SUMMARY
The Somerset County Health Department and McCready Foundation partnered with the Business Economic and Community Outreach Network (BEACON) to sponsor a Health Needs Assessment in Somerset County, Maryland. The goal of this needs assessment was to identify the health concerns of residents and barriers they encounter in accessing health care. A mixed method approach was used to assess the needs, identify resources, and identify opportunities for intervention. With assistance from the Somerset County Health Department and the McCready Foundation Inc., the BEACON team conducted in-depth key informant interviews focus groups accessing over 102 opinion leaders. The BEACON team also accessed secondary data and information from public sources to provide the background and context for the in-depth interviews. The interviews and focus groups were conducted using questions involving the identification, discussion, and/or explanation of health concerns, health trends, and potential methods of prevention or improvement of health concerns in Somerset County. Based on the interviews and focus groups, poverty, low health literacy, transportation barriers, financial constraints, and lack of insurance coverage emerged as the biggest barriers to accessing health care in Somerset County. In addition, obesity and diabetes were identified as major public health concerns for the county. The study participants discussed the lack of exercise programs and weight loss resources in the community. Most study participants listed the Somerset County Health Department as the best source of healthcare information in the county. Finally, the study participants offered the following recommendations to reduce risk factors and improve health outcomes in Somerset County:
1. Seeking Additional Resources (Primarily funding but also volunteers); 2. Pooling Resources within Somerset County and Regionally; 3. Focusing more on Education, Outreach, and Prevention; 4. Strengthening Partnerships (i.e. Faith and Community Based Organizations); 5. Breaking down silos and allocating funding to patients not the providers; 6. Enhancing Case Management.
3
INTRODUCTION
Somerset County, one of the 24 jurisdictions of the State of Maryland1, is located on the
Eastern Shore of Maryland, between the Chesapeake Bay and the Atlantic Ocean. The
County has an estimated population of about 26,000, with 54% being White, 42% African
American, 3.6% Hispanic; 2.4% Multiracial; and 0.9% Asian.2
Somerset County residents have to contend with a number of health needs that exceed the
available resources to address them. The County has been ranked 19th out of 24 in length of
life based on years of potential life lost before age 75 per 100,000 population. With the
highest percentage of children in poverty throughout the state of Maryland (36% under age
18); the highest rate of obesity in Maryland (42% with BMI >30), and a 24.1% smoking rate
among adults, the County’s health needs are significant. There are over 3,000 residents for
each primary care physician in the County putting it last in the State of Maryland.3
This study is an attempt to better quantify and qualify the community health needs in
Somerset County, and to identify the limitations, barriers, and gaps that impact health
outcomes in the County.
1 http://msa.maryland.gov/msa/mdmanual/01glance/html/county.html 2 https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml# 3 http://www.countyhealthrankings.org/app/maryland/2017/rankings/somerset/county/outcomes/overall/snapshot
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STUDY METHODOLOGY
A Community Health Needs Assessment is a method for reviewing the health issues facing a
population, leading to agreed priorities and resource allocation that will improve public
health and reduce inequalities.4 These assessments can be used to identify gaps between
current health status and those desired, and to categorize such gaps via level of importance
and source of influence (environmental, behavior, genetic, or healthcare). Health needs
assessments have many benefits, including the development of strategies to address health
care needs in the community, strengthened community involvement in decision making,
improved communication with agencies and the public in the community, a snapshot of the
health needs of an entire community, and better use of resources.
Limitations of a needs assessment are introduced once the method of research is chosen;
i.e. quantitative versus qualitative. Quantitative research methods of assessment are
objective, number-based, and generalizable. This method is used to test concepts,
constructs, and hypothesis of a theory; examples include surveys, structured interviews,
observations, and reviews of records or documents for numeric information. Qualitative
research methods are subjective, text-based, and less generalizable. Qualitative research is
used to formulate a prediction; examples include focus groups, in-depth interviews and
brainstorming.5
4 https://www.k4health.org/sites/default/files/migrated_toolkit_files/Health_Needs_Assessment_A_Practical_Guide.pdf 5 http://www.orau.gov/cdcynergy/soc2web/Content/phase05/phase05_step03_deeper_qualitative_and_quantitative.htm
5
This study combines quantitative and qualitative approaches. In addition to a thorough
review of the most recent federal, state, and local data sets pertaining to Somerset County’s
health needs and health outcomes, the BEACON Team has conducted a series of opinion
leader and key stakeholder interviews as well as focus groups with key health care
professionals, elected and appointed officials, business and economic development decision
makers, emerging community leaders, and other key informants. The process included data
collection from 102 unique individuals over a three-month period in the fall of 2017. Such
community-based recruiting of key informants is most successful when there is a
partnership between the researchers and local community-based organizations such as
health departments or hospitals. The BEACON Team is grateful to the support of the study
sponsors Somerset County Health Department and the McCready Foundation, Inc. for
assisting in recruiting these study participants. These key informants have provided in-depth
insights to the BEACON Team in better understanding the data and the outcomes observed
through the initial data analysis. The information gathered from the key informants
interviewed was organized as follows:
1. Primary community health needs in Somerset County;
2. Somerset County’s key health outcomes;
3. Health care access, affordability, and inequality issues;
4. Key community health trends (improving/worsening);
5. Gaps in health needs versus available services;
6. Health Literacy Issues.
6
ABOUT SOMERSET COUNTY
Somerset County is located on the Eastern Shore of Maryland, surrounded by Wicomico
County, MD to the North; Worcester County, MD to the East; Accomack County, VA to the
South, and the Chesapeake Bay to the West. It is one of 24 Maryland counties/jurisdictions.
The county has a rural designation, as defined by the United States Census Bureau, hosting
a population of less than 50,000 residents.6 The County includes eleven towns: Chance,
Crisfield, Dames Quarter, Deal Island, Eden, Fairmount, Frenchtown, Mount Vernon,
Princess Anne, Smith Island, and West Pocomoke.7 Somerset County has one hospital, three
health care and social assistance clinics, and three nursing and residential care facilities.
Demographics
Somerset County is home to 26,000 residents. Racially, the county is majority white (54%);
43% black; 0.9% Asian, and less than 1% each of Native American and Hawaiian
backgrounds. 3.6% of the residents identify themselves as Hispanic/Latino. The median age
of the county is 37 years old. In 2016, the Somerset County median household income was
just under $36,000 with 24.3% of the population living in poverty. Housing problems are an
issue, with around 24% of all households (highest in Maryland) experiencing one or more of
the following challenges: overcrowding, high housing costs, or lack of kitchen or plumbing
facilities. A more detailed demographic profile of the County is presented on the following
page in Table 1.
6 https://storymaps.geo.census.gov/arcgis/apps/MapSeries/index.html?appid=9e459da9327b4c7e9a1248cb65ad942a 7 http://maryland.hometownlocator.com/counties/cities,cfips,039,c,somerset.cfm
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Table 1: Demographic Profile of Somerset County
SOMERSET COUNTY DEMOGRAPHICS Population Population estimate, July 1, 2016 25,928 Persons under 5 years, percent, July 1, 2016 4.80% Persons under 18 years, percent, July 1, 2016 17.20% Persons 65 years and over, percent, July 1, 2016 16.00% Female persons, percent, July 1, 2016 46.30% Race and Hispanic Origin White alone, percent, July 1, 2016 53.90% Black or African American alone, percent, July 1, 2016 42.30%
American Indian and Alaska Native alone, percent, July 1, 2016 0.40%
Asian alone, percent, July 1, 2016 0.90%
Native Hawaiian and Other Pacific Islander alone, percent, July 1, 2016 0.10%
Two or More Races, percent, July 1, 2016 2.40% Hispanic or Latino, percent, July 1, 2016 3.60% White alone, not Hispanic or Latino, percent, July 1, 2016 51.40% Population Characteristics Veterans, 2012-2016 1,813 Foreign born persons, percent, 2012-2016 5.10% Housing Housing units, July 1, 2016, (V2016) 11,420 Owner-occupied housing unit rate, 2012-2016 64.40% Median value of owner-occupied housing units, 2012-2016 $131,800
Median selected monthly owner costs -with a mortgage, 2012-2016 $1,218
Median selected monthly owner costs -without a mortgage, 2012-2016 $482
Median gross rent, 2012-2016 $667 Building permits, 2016 25 Families & Living Arrangements Households, 2012-2016 8,328 Persons per household, 2012-2016 2.32
Living in same house 1 year ago, percent of persons age 1 year+, 2012-2016 81.40%
Language other than English spoken at home, percent of persons age 5 years+, 2012-2016 7.40%
Source: U.S. Census Bureau
8
Education In 2017, Somerset County had just under 3,000 students enrolled in K-12 classes.
Approximately 450 of these students were in Pre-K and Kindergarten; 1,135 of them were in
elementary school; 625 in Middle school, and 730 in high school. The County has two Head
Start Centers (Princess Anne and Crisfield) and one private school (Holly Grove Christian).
Overall, 80.5% of the County’s population are high school graduates or higher. College
graduates with Bachelor’s degrees or higher comprise about 15% of the County population.
Economy In 2017, Somerset County had a total labor income of $415 million. The Median household
income in the County is $35,154 and the Average household income is $49,530. At $16,631,
Somerset County’s per capita income is the lowest in the State of Maryland.
Somerset County has a civilian labor force of 9,234 with 8,586 of them employed and 648
unemployed. The unemployment rate is 7% which is the highest in the State of Maryland (almost 3%
higher than the state average). Close to half of County residents commute outside the County for
work. A list of the major employers in the County can be seen on the following page, in Table 2.
Please note that this list excludes post offices, state and local governments, national retail and
national foodservice establishments. In fact, there are close to 3,000 federal, state, and local
government employees working in 43 government establishments in Somerset County, making
public service jobs the largest employment category. Median hourly wages in Somerset County
range from the minimum wage up to $39.85 per hour depending on education, experience and
employment sector. However, in most categories, these median wages put the County at the
bottom in the State of Maryland.
9
Table 2: Major Employers in Somerset County
Source: Maryland Department of Commerce
Housing and Transportation Somerset County has close to 8,500 occupied housing units of which 64.8% are owner
occupied. Over 2,500 units are either currently vacant or abandoned. The median value of
owner occupied housing units is slightly over $130,000 with a median mortgage amount of
$736. The median non-mortgage owner costs are over $480. The median gross rent is $667.
Somerset County is served by US Route 13, a major North-South artery and a speed limited
railroad for freight. The County has access to water transportation via the Ports of Salisbury
and Baltimore. In addition, the Crisfield Harbor serves smaller vessels. Scheduled air service
available at Salisbury-Ocean City Wicomico Regional Airport, 16 miles from Princess Anne;
Crisfield Airport has one 2500’ x 75’ paved, lighted runway, and one 3350’ x 100’ grass
10
runway. Transit services are provided by Shore Transit, a regional public transportation
system.
Crime, Safety, and Disaster Preparedness Violent crime in Somerset County is relatively low at under 280 per 100,000 population.
However, property crime rates are above state averages at close to 1,500 per 100,000
population.
The Somerset County Department of Emergency Services has the mission of coordinating
the resources necessary to respond to an emergency. On a daily basis, this occurs through
the 9-1-1 Emergency Communications Center. For large scale events the Emergency
Operations Center coordinates emergency management services. This agency is the lead
agency in the County for emergency management planning, response, mitigation and
recovery. This office is responsible for the Emergency Operations Center, the County
Emergency Operations Center, the County Emergency Operations Plan, and the Hazardous
Materials Regulatory Program.
Other Societal and Geographic Factors
Based on its demographic, education, economic, and workforce profiles, Somerset County
ranks at the bottom 5% of U.S. counties. In addition, proximity to Worcester County with
Ocean City and Wicomico County with Salisbury means that a large number of the higher
income workers in the County live in these two contiguous counties, creating a leakage of
11
the economic impact or their earnings. This, in turn, exacerbates the resource limitations in
the County for dealing with residents’ needs, including healthcare.
Overview of Community Health Needs in Somerset County
In 2017, Somerset County was ranked 22nd out of 24 in health outcomes and 23rd in health
risks. Some of the key statistics for the County were:
Factor Somerset Maryland Poor or fair health 20% of the Population 13% of the population
Poor physical health days 4.5 3.5
Poor mental health days 4.2 3.4
Low birthweight 8% of births 9% of births
Premature age-adjusted mortality 430 320
Child mortality 130 50
Infant mortality 9 per 1000 Live Births 7 per 1000 Live Births
Frequent physical distress 14% of the population 11% of the population
Frequent mental distress 13% of the population 11% of the population
Diabetes prevalence 14% of the population 10% of the population
HIV prevalence 634 per 100,000 pop. 641 per 100,000 pop. Source: http://www.countyhealthrankings.org – A Robert Wood Johnson Foundation Program
In addition, the Maryland Department of Health’s Office of Minority Health and Health
Disparities has identified ten of fifteen elevated indicators for health disparities including
percent of families in poverty, substance abuse treatment rate, teen birth rate, and
Medicaid enrollment rate. 11% of the population under age 65 in Somerset County is
uninsured. The county holds an unemployment rate of 6.1% as of August 2017. There were
20% of families and people whose income were below the poverty line in 2015.8
8 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF
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Access to Healthcare in Somerset County
In addition to the offerings of the Somerset County Health Department (See:
https://somersethealth.org/ for a comprehensive listing), the McCready Health organization
offers the following services:
24 Hour emergency services at McCready Hospital;
Immediate care/lab & imaging services at Princess Anne;
A behavioral health addictions program and a NA support group;
Assisted living & nursing home/skilled nursing (including rehab and wound care);
Medical-surgical care;
PT, OT, and Speech Therapy;
Pulmonary Rehab;
Pain Clinic, and
A free or $5 flu shots service each season.
McCready has providers in internal medicine, occupational health and surgery (full-time);
pediatrics, cardiology, gynecology and podiatry (by appointment or set days per week or
month). There is also a PA and/or LPN who goes to Smith Island two times a month to see
patients.
In spite of these offerings, virtually all study participants ranked access to healthcare in the
County as one of their top three critical concerns. Many have also noted that the proximity
of Wicomico County with a much higher concentration of healthcare facilities as a positive
factor. However, these same respondents agreed that to a rural population with economic,
workforce, and transportation challenges, this proximity may not be the optimal solution.
13
Limited number of physicians, clinics, offices, urgent care centers, and the sparsely
populated rural nature of the County (transportation barriers) were also mentioned as
access challenges.
Healthcare Affordability in Somerset County
In Somerset County, 13% of adults are without health insurance, compared to 11% in
Maryland as a whole. In children, these rates are 4% for the County compared to 3% in the
State. The older residents with access to Medicare, the low-income residents with access to
Medicare and other affordable options, and a large number of government employees in
the County with employer subsidized health insurance prevent these percentages from
being worse than they are. However, affordability of wellness and nutrition programs,
medication, co-pays, and other out-of-pocket costs make this issue a growing problem for
County residents. When combined with low access to and/or low availability of services,
Somerset County’s low rankings are easier to understand.
Nature and Scope of Healthcare Services in the County
During the key-informant interviews, the lack of an adequate number of healthcare facilities
and professionals in the County was a very common reason given for the troublesome
health outcomes. In addition, about one in three key informants identified the limited scope
of services in existing facilities as a cause for concern. These respondents linked the low
numbers and limited scopes to the lack of resources and the nature of a sparsely populated
14
region where it is not easy to reach a critical mass of clients to absorb the high cost of these
services. Some key service statistics are:
Factor Somerset Maryland Primary care physicians 3,230:1 1,130:1
Dentists 740:1 1,350:1
Mental health providers 500:1 490:01:00
Preventable hospital stays 55 46
Diabetes monitoring 84% (65-75 Yr. Old) 85% (65-75 Yr. Old)
Mammography screening 67% (67-69 Yr. Old) 64% (67-69 Yr. Old) Source: http://www.countyhealthrankings.org – A Robert Wood Johnson Foundation Program
Healthcare Literacy
While most of the respondents listed low health literacy as a contributing factor to
Somerset County’s low health outcome and risk factor rankings, they also acknowledged
the efforts of the County’s Health Department in improving residents’ access to health
information. In addition, the collaborative efforts of the Health Department and of
MrCready Health with the County’s public schools, faith and community based
organizations, and with various government agencies operating in the County were cited as
key strategies for increasing health literacy. There was consensus that such activities suffer
from fairly significant resource limitations. Without adequate outreach and education, the
community health literacy levels are bound to remain low and, consequently, the various
health risk factors are bound to be negatively impacted. Some of the key risk factors that
15
these health literacy outreach/education activities target (to build awareness and to reduce
risks) were identified as follows:
Factor Somerset Maryland Adult smoking 15%Adult obesity 29%Food environment index 8.2Physical inactivity 22%Access to exercise opportunities 93%Excessive drinking 16%Alcohol-impaired driving deaths 33%Sexually transmitted infections 462.6Teen births 25Food insecurity 20% 13%Limited access to healthy foods 11% 3%Drug overdose deaths 18 18Motor vehicle crash deaths 9 9Insufficient sleep 43% 39%
Behavioral Health, Alcohol and Substance Abuse, and Alzheimer’s/Dementia
There are four Behavioral Health Providers, one Recovery & Re-entry Center, and zero
treatment beds in Somerset County. Dementia patients and their caregivers can be
referred to an agency in Cambridge, MD that provides Dementia respite care. The local Area
Agency on Aging (MAC) does not accept dementia patients due to risk of "walking off"; also
clients need to toilet independently to attend. Adult Medical Day Care may be a resource to
some; but the nearest facility is in Salisbury, MD and comes with a cost for some. There are
currently no local support groups. McCready hospital has treated 164 patients with a
primary or secondary diagnosis of dementia in the latest six month period.
16
Most of the key informants interviewed (78 out of 102) expressly linked the major
behavioral health issues in Somerset County first to substance and alcohol abuse and
secondarily to aging related depression and dementia concerns. Other issues voiced by the
respondents included lack of counseling for kids and young adults. When asked what
prevention measures are appropriate to these behavioral health problems, respondents
gave mixed opinions. Access and affordability, stigma, lack of awareness of services
available were all listed as major concerns. Some of the concerns include Excessive Drinking
Prevalence. For Somerset County, this number has gone from around 10% of the population
in 2015 to over 16% of the population in 2017. Deaths in Somerset County attributable to
substance abuse, while low, are on the rise. In 2016 the Maryland Department of Health
reported that Age Adjusted Death Rates for Total Unintentional Intoxication Deaths in
Somerset County had reached 16.9 per 100,000 population, putting the county in the
middle of the 24 jurisdictions of Maryland. Overall, approximately 24% of Somerset
residents have Anxiety related conditions. On a slightly positive note, Alzheimer’s and other
dementia related conditions afflict approximately 2% of Somerset County residents which
puts the County towards the bottom of Maryland jurisdictions.
Tobacco Cessation
The key informants have noted that Somerset County’s tobacco cessation efforts have been
effective. However, they also acknowledge that the County’s smoking rate of 20% is 50%
higher than that of the Maryland average. Diminishing resources, language barriers, and
access to cessation services were identified as barriers to further success.
17
Diet and Obesity
The adult obesity rate in Somerset County is over 42%. This rate is nearly 50% higher than
the Maryland rate. One of the reasons for this is the low Food Environment Index number in
the county. The Food Environment Index ranges from 0 (worst) to 10 (best) and equally
weights two indicators of the food environment:
1. Limited access to healthy foods -- estimates the percentage of the population that is
low income (200% of the federal poverty threshold) for the family size) and does not
live close to a grocery store (more than 10 miles).
2. Food insecurity estimates the percentage of the population who did not have access
to a reliable source of food during the past year.
The Food Environment in Somerset County is rated at 32% below the state average. In
addition, almost a third of county residents do not get adequate physical exercise,
exacerbating the obesity problem. Combined, these factors lead to increased negative
health outcomes through Cardio Vascular Diseases, Diabetes, Cancer, Joint Disease, and
other conditions (which are discussed further in the following sections).
Cardio Vascular Diseases
The Maryland Department of Health estimates Age Adjusted Cardio Vascular Mortality per
100,000 population in Somerset County is close to 300 and increasing while this same ratio
for the state as a whole is under 200 and falling. The study participants attribute the high
18
numbers to (in descending order) obesity, lack of exercise, diabetes, health literacy, and
access issues.
Cancer
The National Cancer Institute estimates that in 2017, the Somerset County Cancer deaths
will be under 500 per 100,000 population. The good news is that this number reflects a
downward trend of about 5% over the past five years. The age adjusted incidence rate per
100,000 population for some major cancer types are as follows:
Cancer Type Somerset Maryland Lung 56.4Colorectal 35.8Breast 125.0Prostate 112.0Melanoma 20.7
Just as in the case for Cardio Vascular Diseases, the study participants attribute these
incidence rates to obesity, lack of exercise, health literacy, and access issues.
Diabetes
According to the data compiled by Dartmouth College for all U.S. jurisdictions, Somerset
County had just under 700 patients between the ages of 65 and 75 that received treatment
for diabetes. About 30% of these patients were African-American. In 2016, these patients
were given over 350 eye exams, just under 500 hemoglobin tests, and over 450 lipid tests as
19
part of their diabetes care. All these numbers were growing at a slightly higher rate than the
population growth in this age group. The difference, however, was not statistically
significant. The study participants list (in descending order) obesity, lack of exercise, health
literacy, and access issues as factors that contribute to the incidence of diabetes and related
ailments in Somerset County. They also list the high (estimated) number of undiagnosed
cases as well as the high number of pre-diabetes cases as major concerns.
Infectious Diseases and Immunization
According to the data compiled by the Maryland Department of Health, Tuberculosis
Incidence rates per 100,000 in Somerset County was 3.8 compared to 4.9 in Maryland as a
whole. For Chlamydia, the Somerset rate was 835.6 compared to 437.9 in Maryland. For
Gonorrhea, the Somerset rate was 115.0 compared to 118.3 in Maryland. A particularly
bright spot was the rate for HIV/AIDS cases in Somerset at 17.7 versus 46.6 in Maryland.
On the immunization front, based on data from County Health Rankings, a Robert Wood
Johnson Foundation Program, Somerset County rates were similar to or even better than
those for other jurisdictions in Maryland. For example, the average % of Kindergarten
Students Immunized in Somerset County was 100.0 compared to 99.3% in Maryland. Adults
Receiving Flu Shots in Somerset County were 37.4% of the population compared to 38.5% in
Maryland. Finally, adults receiving Pneumonia Shots were 29.5% of the County population
compared to 24.7 in Maryland.
20
Maternal and Child Health
The key informants taking part in this needs assessment rated Somerset County’s Maternal and
Child Health services as being adequate and praised the County Health Departments outreach and
partnership efforts. However, slightly more than half of the participants were concerned about the
limited resources available for education, outreach and prevention efforts. In addition, about a third
of the participants were concerned that health literacy issues and language barriers were adding to
these problems.
Environmental Health
The bulk of the environmental health services in the county are provided by the Somerset
County Health Department. These include reviews, approvals, and inspections of private
septic systems and wells; testing well waters; reviewing and approving commercial
development and subdivisions; licensing and inspecting food service facilities (restaurants,
grocery stores, bars, mobile food trucks, food services at fairs & events, and bed and
breakfasts); licensing and inspecting public swimming pools to monitor health and safety
conditions; conducting Rabies investigations and offering vaccination clinics; approving burn
permits, and land plat reviews. About a third of the key informants participating in this
community health assessment listed agriculture as a concern for environmental health.
Water and air pollution were listed as being linked to agriculture. However, the participants
also recognized the progress that was made on these issues over the past 20 years.
21
Oral Health
According to the Maryland Department of Health, more than half of Somerset County
residents have not seen an oral health professional in the past 12 months. This is compared
to slightly over a quarter of the residents of the State of Maryland. About a fifth of the study
participants were concerned about the link between bad oral health and other diseases
such as Cardio Vascular ailments. It should also be noted that the lack of adequate dental
care offerings (Chesapeake Health plus three solo practitioners) in the county was
mentioned by half of the participants. McCready hospital has treated 111 patients in the
most recent six months with a primary dental diagnosis.
SNFs, Extended Care Organizations, and End-of-Life Care
The key informants taking part in this needs assessment praised the activities of the two
Skilled Nursing Facilities in the County (Princess Anne and Crisfield) but also noted the
growing need for elder care and memory care beds. They also discussed the lack of
resources, long-term care insurance coverage and access/affordability barriers to such care
in the county. The participants also praised the outreach efforts of Coastal Hospice in
Somerset County. They noted that in the sparsely populated rural Somerset County, it may
not be economically viable to have a stand-alone end-of-life facility. Finally, Adult
Evaluation services (AERS) of the Somerset County Health Department was listed as a
valuable service. AERS provides assistance to aged and functionally disabled adults who are
at risk of institutionalization. AERS staff conducts a comprehensive evaluation to identify
services available to help the individual to remain in the community, or in the least
22
restrictive environment, while functioning at the highest possible level of independence and
personal well-being (See: https://somersethealth.org/programs/community-health-
nursing/aers-adult-evaluation-review/).
Care Giver Needs
As the population of Somerset County ages, it is increasingly becoming common for family
members to become primary care givers to their aging relatives. Frequently, these care
givers are having to withdraw from the workforce, putting additional burdens on the
households involved. The key informants taking part in this needs assessment noted that
the lack of respite care, limited options for training care givers, and difficulties in securing
adult medical and non-medical day care issues as additional concerns.
Conclusions and Recommendations
The findings discussed in this report have been summarized in a dashboard format in
APPENDIX A (Somerset County Community Health Needs Dashboard). The dashboard
provides a composite score (from 1 Low to 5 High) for each factor and color codes the trend
for each factor. Finally, a comparison with Maryland averages is made for each factor, also
color coded. County Scores and Trends are based on the key informant interview findings.
Comparisons with Maryland outcomes were determined on the basis of these interview
findings as well as the data from the 2017 County Health Rankings for Maryland
(http://www.countyhealthrankings.org/sites/default/files/state/downloads/CHR2017_MD.pdf).
23
The key informants taking part in this needs assessment listed the rural nature of Somerset
County, the low population density, poverty, low educational outcomes, lack of adequate
healthcare services and professionals, and low health literacy as the major challenges. They
praised the efforts of the County Health Department and the McCready Health organization
against this background high risk factors and low outcomes. When asked for
recommendations for improvement, the participants listed the following solutions:
1. Seeking Additional Resources (Primarily funding but also volunteers);
2. Pooling Resources within Somerset County and Regionally;
3. Focusing more on Education, Outreach, and Prevention;
4. Strengthening Partnerships (i.e. Faith and Community Based Organizations);
5. Breaking down silos and allocating funding to patients not the providers;
6. Enhancing Case Management.
These solutions (in descending order of emphasis) were compiled from respondent
comments provided on open ended questions.
24
EXHIBIT 6
Grant Thornton LLP Two Commerce Square 2001 Market St., Suite 700 Philadelphia, PA 19103 T 215.561.4200 F 215.561.1066GrantThornton.comlinkd.in/GrantThorntonUS twitter.com/GrantThorntonUS
Grant Thornton LLP U.S. member firm of Grant Thornton International Ltd
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(In Thousands)
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See accompanying notes.
(In Thousands)
(continued on next page)
(In Thousands)
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(In Thousands)
See accompanying notes.
(In Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
Recognition and Measurement of Financial Assets and Financial Liabilities
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
Revenuefrom Contracts with Customers
Presentation of Financial Statements of Not-for-Profit Entities
Improving the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit Cost
(Dollar Amounts in Thousands)
Leases
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
(Dollar Amounts in Thousands)
U.S. Treasuries
Corporate debt securities and government-sponsored mortgage-backed securities
(Dollar Amounts in Thousands)
Money market funds
Publicly traded equity securities
(Dollar Amounts in Thousands)
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(In
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EXHIBIT 7
Audit and Accounting Guide for Not-For-Profit Entities
“Accounting Standards Codification.”
“Income Taxes”
Property, Plant and Equipment
Investments maintained by the Community Foundation of the Eastern Shore
Presentation of Financial Statements of Not-for-Profit Entities.
Leases.
EXHIBIT 8
EXHIBIT 9
EX
EC
UT
IVE
SU
MM
AR
Y
A n
ew fa
cilit
y sh
ould
be
cons
truc
ted
for a
Fre
esta
ndin
g M
edic
al
Faci
lity
(FM
F) to
mee
t the
hea
lthc
are
need
s of
the
Cris
field
co
mm
unity
. A n
ewly
con
stru
cted
bui
ldin
g w
ill p
rovi
de s
tate
-of-
the
art f
acili
ties,
be e
ffici
ent t
o op
erat
e an
d m
inim
ize
disr
uptio
n to
he
alth
care
ser
vice
s du
ring
the
cons
truc
tion
perio
d. T
he n
ew fa
cilit
y w
ill s
uppo
rt c
linic
al s
ervi
ces
for g
ener
atio
ns.
The
reco
mm
enda
tion
to c
onst
ruct
a n
ew fa
cilit
y w
as re
ache
d af
ter
thor
ough
eva
luat
ion,
whi
ch in
clud
ed th
e co
nsul
tant
s, co
nstr
uctio
n m
anag
er a
nd P
RM
C. T
hrou
gh th
is e
valu
atio
n, w
e de
term
ined
fa
ctor
s in
clud
ing
cost
, dur
atio
n of
con
stru
ctio
n, le
vel o
f fru
stra
tion,
co
ordi
natio
n eff
orts
and
cod
e-re
late
d de
sign
con
side
ratio
ns s
houl
d el
imin
ate
the
reno
vatio
n op
tion
from
con
side
ratio
n. R
efer
to S
ectio
n 3D
and
rela
ted
Atta
chm
ents
.
CO
NT
EN
TS
INT
RO
DU
CT
ION
1
EX
IST
ING
CO
ND
ITIO
NS
AT
MC
CR
EA
DY
2A
S
erv
ice
s C
urr
en
tly
Pro
vid
ed
B
Ex
isti
ng
Ph
ysic
al
Pla
nt
AN
ALY
SIS
OF
OP
TIO
NS
FO
R M
CC
RE
AD
Y3
A
Se
rvic
es t
o b
e P
rov
ide
d
B
Op
po
rtu
nit
ies /
Lim
ita
tio
ns
C
Op
tio
n 1
: M
inim
um
/ S
ho
rt T
erm
D
Op
tio
n 2
: R
en
ov
ati
on
E
Op
tio
n 3
: N
ew
Co
nstr
uc
tio
n /
Re
pla
ce
me
nt
RE
CO
MM
EN
DA
TIO
N4
INT
RO
DU
CT
ION
Se
cti
on
1:
CRTK
L| 1
Pa
rtic
ipa
nts
Peni
nsul
a Re
gion
al M
edic
al C
ente
r (PR
MC
) eng
aged
the
follo
win
g fir
ms
to h
elp
anal
yze
exis
ting
cond
ition
s an
d su
ppor
t rec
omm
enda
tions
for a
futu
re c
ours
e
of a
ctio
n:
•
Ca
llis
on
RT
KL
, A
rchi
tect
ural
Ser
vice
s, W
ashi
ngto
n, D
C•
Le
ac
h W
all
ac
e, M
echa
nica
l/El
ectr
ical
/Plu
mbi
ng E
ngin
eerin
g, E
lkrid
ge, M
D•
Wh
itin
g-T
urn
er,
Cons
truc
tion
Cons
ultin
g an
d Co
st E
stim
atin
g, S
alis
bury
, MD
Pro
ce
ss U
se
d f
or
An
aly
sis
an
d F
orm
ati
on
of
Re
co
mm
en
da
tio
n
•
An
aly
sis
of
Da
ta: T
he M
cCre
ady
staff
mad
e dr
awin
gs in
bot
h ha
rd c
opy
and
Aut
oCA
D a
vaila
ble
to th
e PR
MC
sta
ff a
nd c
onsu
ltan
ts. A
dditi
onal
in
form
atio
n w
as g
athe
red
from
pub
licly
ava
ilabl
e so
urce
s su
ch a
s
Goo
gle
Map
s.
•
Sit
e V
isit
s: S
e ver
al v
isits
wer
e m
ade
to th
e M
cCre
ady
cam
pus
by s
taff
m
embe
rs o
f PR
MC
, Cal
lison
RTK
L an
d Le
ach
Wal
lace
. Par
ticip
ants
wal
ked
thro
ugh
the
hosp
ital (
clin
ical
, adm
inis
trat
ive
and
MEP
spa
ces)
, as
wel
l as
arou
nd th
e ex
terio
r.
•
Me
eti
ng
s w
ith
Sta
ff: M
cCr e
ady
staff
wer
e ve
ry h
elpf
ul in
ans
wer
ing
ques
tions
abo
ut th
e fa
cilit
y, hi
stor
y an
d on
goin
g pr
ojec
ts:
• K
en S
tirlin
g•
Ric
h Si
pe
Ke
y D
ate
s
OC
TO
BE
R 1
, 20
18
AU
GU
ST
23
, 20
21
JU
LY 1
, 20
19
Targ
et d
ate
for a
de
cisi
on to
be
mad
e by
th
e PR
MC
and
McC
read
y bo
ards
of d
irect
ors
Targ
et d
ate
for t
he S
tate
of M
aryl
and
to is
sue
a Ce
rtifi
cate
of E
xem
ptio
n,
thus
per
mitt
ing
the
conv
ersi
on o
f M
cCre
ady
Mem
oria
l Hos
pita
l to
a Fr
eest
andi
ng M
edic
al F
acili
ty (F
MF)
. Th
is is
als
o th
e da
te th
at P
RM
C w
ould
be
gin
desi
gn a
nd/o
r con
stru
ctio
n to
cr
eate
the
faci
lity
to s
erve
as
the
FMF.
Targ
et d
ate
to
occu
py th
e FM
F
WH
Y I
S T
HIS
RE
PO
RT
BE
ING
WR
ITT
EN
?
The
curr
ent s
tatu
s of
McC
read
y M
emor
ial H
ospi
tal i
s no
t sus
tain
able
. The
nu
mbe
r of i
npat
ient
s ha
s de
clin
ed to
a p
oint
whe
re c
onve
rsio
n to
a F
rees
tand
ing
Med
ical
Fac
ility
(FM
F) a
ppea
rs to
be
inev
itabl
e. T
he o
pera
ting
expe
nses
of t
he
curr
ent p
hysi
cal p
lant
are
gre
ater
than
the
curr
ent p
atie
nt v
olum
es c
an s
usta
in.
EX
IST
ING
CO
ND
ITIO
NS
AT
MC
CR
EA
DY
Se
cti
on
2:
CRTK
L| 2
2.A
SE
RV
ICE
S C
UR
RE
NT
LY P
RO
VID
ED
2.B
EX
IST
ING
PH
YS
ICA
L P
LA
NT
Sit
e
The
site
is a
pen
insu
la a
nd s
its v
ery
near
the
wat
er. I
n re
cent
sto
rm e
vent
s, no
wat
er w
as
repo
rted
to h
ave
ente
red
clin
ical
spa
ces
alth
ough
som
e su
ppor
t are
as h
ave
been
floo
ded.
An
aeria
l vie
w o
f the
site
of M
cCre
ady
Mem
oria
l Hos
pita
l in
Cris
field
, MD
Site
pla
n sh
owin
g th
e ex
istin
g ho
spita
l and
nur
sing
hom
e.
The
boile
r pla
nt is
sha
red
betw
een
the
two
faci
litie
s.
• Th
e Em
erge
ncy
Dep
artm
ent i
s cu
rren
tly
repo
rted
to re
ceiv
e 12
pat
ient
s/da
y
• Th
e Av
erag
e D
aily
Cen
sus
for i
npat
ient
s is
bel
ow 2
• O
ther
ser
vice
s ar
e pr
ovid
ed, i
nclu
ding
su
rger
y, im
agin
g, la
bora
tory
, ph
arm
acy,
outp
atie
nt c
linic
s an
d re
habi
litat
ion
med
icin
e
3
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
The
1929
bui
ldin
gs a
s se
en fr
om th
e br
idge
ent
erin
g th
e si
te.
Arc
hit
ec
ture
This
stu
dy in
clud
ed th
e M
cCre
ady
Mem
oria
l Hos
pita
l, M
cCre
ady
Out
patie
nt
Cent
er a
nd M
cCre
ady
Out
patie
nt R
ehab
ilita
tion.
Oth
er e
ntiti
es (A
lice
B. T
awes
N
ursi
ng &
Reh
abili
tatio
n Ce
nter
and
Che
sape
ake
Cove
r Ass
iste
d Li
ving
) wer
e no
t pa
rt o
f thi
s st
udy.
The
hosp
ital h
as a
bout
16
build
ings
incl
udin
g co
nnec
tions
bet
wee
n bu
ildin
gs, b
ut
excl
udin
g fr
ee-s
tand
ing
outb
uild
ings
. The
bui
ldin
gs w
ere
cons
truc
ted
betw
een
1929
and
200
0. (N
ote
that
the
boile
r pla
nt w
as e
xpan
ded
in 2
008
as p
art o
f the
nu
rsin
g ho
me
proj
ect t
hat f
ollo
wed
sho
rtly
ther
eaft
er, h
owev
er, t
hese
bui
ldin
gs
are
not p
art o
f the
hos
pita
l.) T
he h
ospi
tal b
uild
ings
tota
l jus
t ove
r 70,
000
BG
SF
with
abo
ut 6
0% o
f the
spa
ce in
the
“198
0” B
uild
ing
with
its
min
or a
dditi
ons.
The
build
ings
are
in re
lativ
ely
good
sha
pe fo
r the
ir ag
e. T
hey
have
no
visi
ble
stru
ctur
al is
sues
and
hav
e re
ceiv
ed li
mite
d up
grad
es s
uch
as re
plac
emen
t w
indo
ws
in s
ome
olde
r bui
ldin
gs, a
nd n
o vi
sibl
e ro
of le
akag
e on
the
uppe
r floo
rs.
Som
e of
the
olde
r bui
ldin
gs h
ave
rece
ntly
rece
ived
new
inte
rior fi
nish
es a
nd s
ome
inte
rior r
enov
atio
ns.
The
build
ings
that
pre
date
the
1980
bui
ldin
g ha
ve v
ery
smal
l foo
tprin
ts a
nd a
re
unlik
ely
to ju
stify
the
expe
nse
of s
igni
fican
t ren
ovat
ion
to s
uppo
rt s
tate
-of-
the-
art c
linic
al fu
nctio
ns. S
ever
al o
ut b
uild
ings
are
use
d fo
r sto
rage
; the
y w
ere
not
eval
uate
d as
par
t of t
his
stud
y.
The
1980
bui
ldin
g ha
s a
reas
onab
le c
olum
n sp
acin
g fo
r mod
ern
clin
ical
func
tions
, ho
wev
er, i
t sits
onl
y 9’
abo
ve th
e hi
gh-t
ide
wat
er m
ark
(the
new
nur
sing
hom
e si
ts
at 1
0’-6
”) a
nd p
art o
f the
sur
gica
l sui
te e
ncro
ache
s up
on th
e 10
0’ c
ritic
al b
uffer
ar
ea o
f the
site
.
All
build
ings
pre
date
the
adop
tion
of th
e A
mer
ican
s w
ith D
isab
ilitie
s A
ct, a
nd v
ery
few
mod
ifica
tions
hav
e be
en u
nder
take
n to
add
ress
acc
essi
bilit
y co
ncer
ns. M
any
requ
irem
ents
of c
urre
nt c
odes
and
sta
ndar
ds a
re n
ot b
eing
met
in th
e cu
rren
t bu
ildin
gs.
Add
ress
ing
arch
itect
ural
and
med
ical
cod
e de
ficie
ncie
s w
ould
mos
t lik
ely
requ
ire a
tota
l gut
and
reno
vatio
n of
the
spac
es.
CRTK
L| 4
M.E
.P. S
yste
ms
The
engi
neer
ing
infr
astr
uctu
re is
abo
ut 4
0 ye
ars
old
and
has
been
mai
ntai
ned
on
a tig
ht b
udge
t. Th
e sy
stem
s do
not
mee
t cur
rent
cod
es fo
r hos
pita
ls. A
full
repo
rt
is in
clud
ed in
the
App
endi
x.
The
exis
ting
hosp
ital b
uild
ings
are
fully
spr
inkl
ered
.
The
hosp
ital c
entr
al p
lant
incl
udes
the
follo
win
g m
ajor
sys
tem
s:
• Tw
o 10
0 ps
ig h
igh
pres
sure
ste
am b
oile
rs a
nd s
uppo
rt s
yste
ms
incl
udin
g a
deae
rato
r (no
t fun
ctio
ning
) and
con
dens
ate
retu
rn s
yste
m.
The
boile
rs o
nly
sour
ce o
f fue
l is
fuel
oil.
• 13
0 to
n ro
ofto
p ai
r coo
led
chill
er (n
ot fu
nctio
ning
and
aba
ndon
ed in
pla
ce)
• D
omes
tic b
oost
er p
ump
(ser
ves
both
hos
pita
l and
nur
sing
hom
e).
Per s
taff
in
put,
the
syst
em is
und
ersi
zed.
• St
eam
fire
d 1,
200
gallo
n ta
nk ty
pe d
omes
tic w
ater
hea
ter
• M
edic
al v
acuu
m p
ump
(leak
ing
oil)
• 25
,000
gal
lon
unde
rgro
und
fuel
oil
stor
age
tank
(ser
ves
the
boile
rs a
nd
gene
rato
rs)
• Fi
re p
ump
(con
nect
ed to
an
exis
ting
6” w
ater
ser
vice
and
has
chu
rn is
sues
)
• El
ectr
ical
The
“198
0” b
uild
ing,
the
curr
ent m
ain
entr
ance
of t
he h
ospi
tal.
AN
ALY
SIS
OF
OP
TIO
NS
FO
R
MC
CR
EA
DY
Se
cti
on
3:
CRTK
L| 5
Se
rvic
e L
ine
s
•
Co
nv
ers
ion
to
FM
F:
The
inpa
tient
bed
s an
d su
rger
y se
rvic
es w
ill b
e di
scon
tinue
d. A
n ap
plic
atio
n w
ill b
e fil
ed w
ith th
e St
ate
of M
aryl
and
to is
sue
a Ce
rtifi
cate
of E
xem
ptio
n. T
he F
MF
serv
ices
will
be
oper
ated
as
depa
rtm
ents
of
the
PRH
S.
•
Em
erg
en
cy
De
pa
rtm
en
t: 1
tria
ge ro
om, 3
trea
tmen
t roo
ms,
1 ov
ersi
zed
trea
tmen
t/pr
oced
ure
room
, 2 o
bser
vatio
n ro
oms
with
priv
ate
toile
t/sh
ower
(1
of w
hich
to b
e an
Airb
orne
Infe
ctio
n Is
olat
ion
room
), an
d 2
secu
re h
oldi
ng
room
s.
•
Ima
gin
g D
ep
art
me
nt:
1 ra
diog
raph
y ro
om, 1
CT,
1 u
ltra
soun
d ro
om; P
AC
S w
ith re
mot
e re
adin
g ca
pabi
lity
•
La
bo
rato
ry:
Spec
imen
col
lect
ion
area
s fo
r blo
od a
nd u
rine;
spa
ce fo
r se
lect
ed a
naly
zers
•
Cri
sfi
eld
Cli
nic
: Ex
am ro
oms
and
supp
ort s
pace
s to
acc
omm
odat
e up
to
4 pr
ovid
ers
sim
ulta
neou
sly.
This
clin
ic s
houl
d co
nnec
t to
the
Emer
genc
y D
epar
tmen
t so
clin
ical
ser
vice
s an
d st
aff c
an s
win
g be
twee
n th
e tw
o de
part
men
ts.
•
Ou
tpa
tie
nt
Re
ha
bil
ita
tio
n M
ed
icin
e:
2 Co
nsul
tatio
n ro
oms,
1 gr
oup
ther
apy
room
and
sup
port
spa
ces
to a
ccom
mod
ate
up to
3 p
rovi
ders
The
follo
win
g is
a s
umm
ary
of th
e pr
opos
ed d
epar
tmen
ts. A
dditi
onal
det
ail c
an
be fo
und
in th
e sp
ace
prog
ram
and
sta
ffing
pla
n in
clud
ed in
the
App
endi
x.
NS
F
Incl
uded
in S
uppo
rt S
ervi
ces
1,
626
8
.0%
658
3
.0%
752
23
,35
9
Sum
mar
y of
the
spac
e pr
ogra
m o
f exi
stin
g an
d pr
opos
ed fa
cilit
ies.
DG
SF
1,58
62,
751
5,55
72,
343
1,26
7
0
1,34
63,
000
2,47
3
20,3
24
BG
SF
De
pa
rtm
en
t
Adm
inis
trat
ion
Cris
field
Clin
icFr
eest
andi
ng E
.D.
Imag
ing
Labo
rato
ryPh
arm
acy
Psyc
h–O
utpa
tient
Phys
ical
The
rapy
Supp
ort S
ervi
ces
Subt
otal
s:
Com
mun
icat
ions
/LA
N C
lose
tsCo
mm
on C
ircul
atio
nM
ech/
Plum
bing
Allo
wan
ceB
uild
ing
Enve
lope
TO
TA
L E
ST
IMA
TE
D B
GS
F
DG
SF
? ? 2,64
03,
324
1,26
71,
460
1,50
04,
624
?
Sta
ff o
n
Ma
in S
hif
t
10.6
10 8 3.5
3 1 3 4.2
7 50
To
tal
Sta
ff
10.6
09.
8028
.86
6.43
5.95
1.10
3.00
4.20
15.3
8
83.3
2
EX
IST
ING
PR
OP
OS
ED
1,17
51,
965
3,70
51,
562
1,01
4
0
88
02,
308
1,90
2
14,5
11
3.A
SE
RV
ICE
S T
O B
E P
RO
VID
ED
• M
inor
reno
vatio
ns to
impr
ove
func
tiona
lity
• A
ny re
quire
d re
pairs
for e
quip
men
t tha
t fai
ls•
No
impr
ovem
ents
to b
ring
the
build
ing
or s
yste
ms
up
to
curr
ent c
odes
and
sta
ndar
ds in
the
inte
rim p
erio
d
Th
e f
oll
ow
ing
se
cti
on
s d
esc
rib
e l
on
g-t
erm
str
ate
gie
s f
or
po
sit
ion
ing
Mc
Cre
ad
y t
o s
up
po
rt h
ea
lth
ca
re n
ee
ds
of
the
co
mm
un
ity. A
ny
of
the
se
str
ate
gie
s a
re l
ike
ly t
o t
ak
e m
on
ths, i
f n
ot
a c
ou
ple
of
ye
ars
, to
im
ple
me
nt.
Th
e s
ho
rt-t
erm
str
ate
gy
to
ke
ep
th
e m
ed
ica
l fa
cil
ity
op
era
tio
na
l u
nti
l 2
02
1 i
s p
rop
ose
d t
o b
e l
imit
ed
to
:
6
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
3.B
OP
PO
RT
UN
ITIE
S/L
IMIT
AT
ION
S
No
build
ings
are
his
toric
, any
bui
ldin
gs c
an b
e co
nsid
ered
for d
emol
ition
The
leve
l of t
he g
roun
d flo
or o
f the
hos
pita
l bui
ldin
gs is
at 9
’ abo
ve s
ea le
vel a
nd
cann
ot re
ason
ably
be
chan
ged.
The
new
nur
sing
hom
e is
at 1
0’-6
” abo
ve s
ea le
vel
and
the
high
er le
vel i
s ve
ry re
ason
able
giv
en th
e pr
oxim
ity to
the
wat
er a
nd th
e po
tent
ial o
f floo
ding
due
to s
torm
s. A
ltho
ugh
clin
ical
leve
ls o
f the
hos
pita
l hav
e ne
ver fl
oode
d, fl
ood
wat
ers
have
bee
n re
port
ed to
hav
e flo
oded
ser
vice
are
as.
3.C
OP
TIO
N 1
: D
O T
HE
MIN
IMU
M/C
ON
TIN
UIT
Y O
F
OP
ER
AT
ION
S W
HIL
E L
ON
G T
ER
M P
LA
N I
S D
EV
EL
OP
ED
Exis
ting
oper
atio
ns m
ay c
ontin
ue u
nder
cur
rent
con
ditio
ns. M
inor
impr
ovem
ents
, as
not
ed h
erei
naft
er, a
re re
quire
d fo
r min
imal
cod
e co
mpl
ianc
e an
d ap
prop
riate
pa
tient
car
e.
As a
n e
xa
mp
le, m
inim
al
imp
rov
em
en
ts i
nc
lud
e:
• Pr
ovid
e su
pple
men
tal a
ir co
nditi
onin
g fo
r the
prim
ary
data
clo
set
• Re
plac
e th
e N
urse
Cal
l Sys
tem
in th
e Em
erge
ncy
Dep
artm
ent
• Co
ntin
genc
y fo
r sig
nific
ant s
yste
m fa
ilure
• D
ue to
the
age
of th
e bu
ildin
gs a
nd M
EP s
yste
ms,
all s
yste
ms
and
equi
pmen
t is
bey
ond
thei
r Li
fe C
ycle
with
the
exce
pt th
at in
stal
led
with
the
Nur
sing
H
ome
• To
con
tinue
ope
ratio
n of
thes
e sy
stem
s fo
r in
exce
ss o
f tw
o ye
ars,
it is
es
timat
ed a
Con
tinge
ncy
Fund
of
$2,0
00,0
00 to
cov
er re
ntal
of t
empo
rary
eq
uipm
ent u
nder
Cat
astr
ophi
c Fa
ilure
• Re
quire
d Im
prov
emen
ts to
mai
ntai
n “s
tatu
s qu
o”
Cu
rre
nt
De
sig
n /
Op
era
tio
na
l D
efi
cie
nc
ies
• Re
plac
e w
indo
ws
thro
ugho
ut•
ED: i.
Prov
ide
priv
ate
room
sii.
Pr
ovid
e ic
e m
achi
neiii
. Pr
ovid
e A
irbor
ne In
fect
ion
Isol
atio
n ro
om
Co
de
De
fic
ien
cie
s
• A
DA
• M
EP
Add
ress
ing
MEP
upg
rade
s w
ill b
ring
abou
t maj
or d
isru
ptio
ns. A
list
of t
he
reco
mm
ende
d M
EP u
pgra
des
is a
ttac
hed
for r
efer
ence
.
Acc
ount
ing
1.00
Adm
inis
trat
ion
3.00
Adm
issi
ons
7.00
Beh
avio
ral H
ealth
3.00
Com
mun
icat
ions
1.60
Cour
ier
3.00
Cris
field
Clin
ic9.
80
Emer
genc
y D
epar
tmen
t13
.35
Envi
ronm
enta
l Ser
vice
s3.
28
Hum
an R
esou
rces
1.00
Info
rmat
ion
Tech
nolo
gy3.
00
Labo
rato
ry5.
95
Mai
nten
ance
5.10
Mat
eria
ls M
anag
emen
t1.
00
Med
ical
Rec
ords
1.00
Patie
nt A
ccou
nts
2.00
Patie
nt S
ervi
ces
1.00
Phar
mac
y1.
10
Phys
ical
The
rapy
2.60
Prin
cess
Ann
e Cl
inic
6.40
Radi
olog
y4.
93
Radi
olog
y C
T0.
50
Resp
irato
ry T
hera
py4.
93
Secu
rity
4.48
Spee
ch T
hera
py0.
60
Tota
l90
.62
Staff
pla
n fo
r the
FM
F.
CRTK
L| 7
Plan
of t
he fi
rst fl
oor o
f the
198
0 bu
ildin
g w
ith “s
hort
-ter
m” r
enov
atio
n ar
eas
show
n in
gre
en.
Plan
of t
he fi
rst fl
oor o
f the
198
0 bu
ildin
g w
ith “s
hort
-ter
m” r
enov
atio
n ar
eas
show
n in
gre
en.
8
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
a.
Prov
ide
prop
er s
ealin
g an
d dr
aina
ge fo
r em
erge
ncy
gene
rato
r. G
ener
ator
cu
rren
tly
has
stan
ding
wat
er in
bas
e of
gen
erat
or a
roun
d co
ndui
ts
prov
idin
g po
wer
to g
ener
ator
bat
terie
s an
d ac
cess
orie
s.b.
Pr
ovid
e ne
w E
D n
urse
cal
l sys
tem
. The
exi
stin
g nu
rse
call
syst
em a
ppea
rs
to b
e in
oper
able
, and
mod
ifica
tions
/upg
rade
s w
ould
be
diffi
cult
due
to it
s ag
e an
d co
nditi
on.
c.
Inst
all a
dditi
onal
nor
mal
and
em
erge
ncy
elec
tric
al re
cept
acle
s in
ED
pa
tient
bay
s to
mee
t the
min
imum
cod
e re
quire
men
ts. C
urre
ntly
, the
ED
bay
s ha
ve a
sin
gle
quad
rece
ptac
le (w
hich
mea
ns 4
rece
ptac
les
for
plug
s), a
nd th
e co
nstr
uctio
n gu
idel
ines
requ
ired
12 re
cept
acle
s, w
ith
appr
oxim
atel
y ha
lf on
em
erge
ncy
pow
er a
nd h
alf o
n no
rmal
pow
er. T
he
exis
ting
quad
out
lets
are
eith
er o
n no
rmal
or e
mer
genc
y, an
d no
t bot
h no
rmal
and
em
erge
ncy.
We
prop
ose
addi
ng e
ither
an
emer
genc
y or
no
rmal
circ
uit t
o ea
ch b
ay, a
s w
ell a
s 2
addi
tiona
l qua
ds p
er b
ay.
d.
Perf
orm
gro
undi
ng te
sts
on th
e ex
istin
g bu
ildin
g.e.
Pe
rfor
m p
reve
ntat
ive
mai
nten
ance
(PM
) on
the
exis
ting
mai
n no
rmal
po
wer
sw
itchb
oard
. The
exi
stin
g bo
lted
pres
sure
sw
itche
s re
quire
si
gnifi
cant
mai
nten
ance
, and
it is
not
cle
ar if
this
has
bee
n re
gula
rly
perf
orm
ed.
f. In
stal
l add
ition
al n
orm
al a
nd e
mer
genc
y el
ectr
ical
rece
ptac
les
in re
-br
ande
d Tr
aum
a Ro
om (c
urre
ntly
OR
) to
mee
t cod
e m
inim
um q
uant
ities
. Th
e ex
istin
g op
erat
ing
room
s on
ly h
ave
10 a
nd 1
2 re
cept
acle
s (f
or O
Rs
#1
and
#2
resp
ectiv
ely)
. Als
o br
ing
two
bran
ches
of p
ower
into
ope
ratin
g ro
om a
s ro
om is
sol
ely
serv
ed fr
om c
ritic
al p
ower
cur
rent
ly.
g.
Cons
ider
rem
ovin
g tw
ist l
ock
plug
s in
the
trau
ma
room
. (O
ptio
nal)
h.
Cons
ider
add
ing
a co
de b
lue
func
tion
to th
e nu
rse
call
syst
em in
the
ED
and
Trau
ma
Room
, as
none
exi
sts
toda
y. (O
ptio
nal)
i. Pr
ovid
e ge
nera
tor a
nnun
ciat
or in
24
hour
man
ned
loca
tion
or m
an th
e bo
iler p
lant
offi
ce a
roun
d th
e cl
ock.
j. Fi
lter a
nd tr
eat t
he fu
el in
the
exis
ting
mai
n un
derg
roun
d fu
el s
tora
ge
tank
and
day
tank
s to
con
firm
fuel
is c
lean
and
usa
ble.
k.
Confi
rm w
hat P
RM
C in
sura
nce
com
pany
(Chu
bb) w
ill re
quire
.l.
Nee
d 2
sour
ces
of fu
el fo
r ste
am b
oile
rs p
rovi
ding
hea
t to
patie
nt ro
oms
and
clin
ical
spa
ces.
Exte
nd a
nd c
onne
ct to
exi
stin
g pr
opan
e ga
s m
ain
serv
ing
the
nurs
ing
hom
e bo
ilers
. Rep
lace
exi
stin
g bu
rner
noz
zles
and
tr
im w
ith d
ual f
uel e
quip
men
t.m
. Th
ere
is n
o ba
ckflo
w p
reve
nter
vis
ible
on
the
hosp
ital 4
” CW
. Add
a B
FP.
(Op t
iona
l)n.
Re
mov
e lo
cal d
ehum
idifi
ers
from
OR’
s.o.
Th
ere
is c
urre
ntly
onl
y on
e m
edic
al g
as m
aste
r ala
rm p
anel
, ins
talle
d a
room
that
is n
ot 2
4 ho
ur m
onito
red.
Add
sec
ond
mas
ter a
larm
pan
el p
er
code
and
ext
end
to B
AS.
p.
Confi
rm A
TC s
yst e
m is
on
emer
genc
y po
wer
. If n
ot, r
e-fe
ed to
e-p
ower
.q.
A
dd d
econ
tam
inat
ion
show
er a
nd h
oldi
ng ta
nk to
ED
. (O
ptio
nal)
r. Pr
ovid
e M
EP c
onne
ctio
ns fo
r the
new
AD
A b
athr
oom
s/si
nks
in th
e ED
(e
xhau
st, s
anita
ry, v
ent,
dom
estic
wat
er).
s. Te
st/c
lean
/adj
ust/
retr
o-co
mm
issi
on e
xist
ing
AH
U’s
.t.
AH
U-1
and
AH
U-2
dua
l-duc
t sys
t em
has
an
exis
ting
high
hum
idity
issu
e.
The
hot d
eck
rece
ives
raw
out
side
air
that
doe
s no
t pas
s ov
er a
coo
ling
coil
first
, and
is n
ot d
ehum
idifi
ed. (
Opt
iona
l)u.
Re
pair/
repl
ace
med
ical
vac
uum
pum
p. It
is le
akin
g a
lot o
f oil.
(Opt
iona
l)v.
Roof
– m
edic
al v
acuu
m d
isch
arge
is 2
’ fro
m o
pena
ble
nurs
ing
hom
e w
indo
w. (
Opt
iona
l)w
. Re
pair/
com
plet
e th
e in
stal
latio
n of
the
boile
r em
erge
ncy
shut
-off
sw
itche
s; th
ey a
re c
urre
ntly
not
wire
d.
x.
PM/c
lean
/insp
ect e
xist
ing
sani
tary
lift
sta
tion
and
pum
ps
List
of M
.E.P
. eng
inee
ring
issu
es to
be
addr
esse
d in
the
shor
t ter
m.
Min
imu
m W
ork
to
Ma
inta
in C
urr
en
t O
cc
up
an
cy
fo
r 2
Ye
ars
CR
TKL
| 9
Sh
ort
Te
rm O
pti
on
Min
imal
cha
nges
are
app
ropr
iate
as
tem
pora
ry m
easu
res
to im
prov
e op
erat
iona
l effi
cien
cies
unt
il a
mor
e pe
rman
ent s
olut
ion
is d
evel
oped
.
Arc
hit
ec
tura
l S
tra
teg
y
The
desi
gn te
am re
com
men
ds th
e fo
llow
ing
chan
ges
to th
e Em
erge
ncy
Dep
artm
ent t
o im
prov
e sh
ort-
term
effi
cien
cies
:
• A
dd a
bat
hroo
m a
nd a
win
dow
to th
e ex
terio
r to
one
of th
e ED
bay
s. Th
is
wou
ld a
llow
the
room
to b
e us
ed fo
r ext
ende
d st
ays,
and
poss
ibly
allo
w a
n in
patie
nt to
rem
ain
in th
e ED
rath
er th
an re
quiri
ng th
e se
cond
floo
r of t
he
hosp
ital t
o be
ope
ned
for a
sin
gle
patie
nt.
• Th
e m
edic
atio
ns s
tatio
n an
d no
uris
hmen
t sta
tion
wou
ld b
e re
loca
ted
to th
e ex
istin
g do
ctor
room
whe
re p
lum
bing
exi
sts.
An
ice
mak
er s
houl
d be
add
ed a
t th
is lo
catio
n.
• A
n ex
istin
g co
rrid
or s
houl
d be
clo
sed
off to
pro
vide
sto
rage
spa
ce fo
r the
ED
.
• Th
e Su
rger
y D
epar
tmen
t soi
led
utili
ty ro
om c
ould
to b
e co
nver
ted
to a
do
ctor
’s ro
om (c
ombi
natio
n on
-cal
l roo
m a
nd o
ffice
).
The
chan
ges
have
bee
n pr
opos
ed to
min
imiz
e bo
th th
e co
st a
nd th
e di
srup
tion/
time
requ
ired
for c
onst
ruct
ion.
Th
e e
sti
ma
ted
co
st
for
the
se
im
pro
ve
me
nts
is
$7
5,0
00
.
M.E
.P. S
tra
teg
y
Plea
se s
ee th
e lis
t of M
.E.P
. ite
ms
that
requ
ire d
ecis
ions
. Th
e e
sti
ma
ted
co
st
for
the
se
im
pro
ve
me
nts
is $
60
0,0
00
- $
90
0,0
00
ba
se
d o
n o
pti
on
al
imp
rov
em
en
ts.
10
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
3.D
OP
TIO
N 2
: R
EN
OV
AT
ION
The
follo
win
g se
ctio
n de
scrib
es e
ffor
ts th
at w
ere
perf
orm
ed a
s pa
rt o
f “du
e di
ligen
ce”,
how
ever
, ren
ovat
ion
is n
ot c
onsi
dere
d to
be
feas
ible
for r
easo
ns li
sted
in
Se
cti
on
4. R
ec
om
me
nd
ati
on
.
An
aly
sis
of
“O
ld B
uil
din
gs”
The
old
build
ings
hav
e ra
diat
ors
for h
eat a
nd w
indo
w a
ir co
nditi
onin
g un
its. A
lso,
th
e ol
dest
bui
ldin
gs a
ppea
r to
be w
ood
cons
truc
tion.
The
orig
inal
2-s
tory
bui
ldin
g ha
s on
ly o
ne s
tairw
ay a
nd a
n ex
terio
r fire
esc
ape.
Giv
en th
e sm
all f
ootp
rints
of
thes
e in
terc
onne
cted
bui
ldin
gs, i
t will
be
expe
nsiv
e an
d no
t effi
cien
t to
brin
g th
em
up to
cur
rent
cod
es a
nd s
tand
ards
for i
nstit
utio
nal f
unct
ions
.
An
encl
osed
con
nect
ion
to th
e nu
rsin
g ho
me
is re
com
men
ded
to a
llow
ser
vice
s, st
aff a
nd p
atie
nts
to b
e sh
ared
bet
wee
n th
e fa
cilit
ies.
The
1980
bui
ldin
g is
the
only
bui
ldin
g th
at m
ight
be
feas
ible
for r
enov
atio
n. T
his
build
ing
has
the
follo
win
g ad
vant
ages
ove
r the
oth
er b
uild
ings
:
• Th
e ge
omet
ry o
f the
floo
r pla
tes
is g
ener
ous.
• Th
e st
ruct
ural
sys
tem
con
sist
s of
wel
l-spa
ced
colu
mns
. •
The
build
ing
is c
onne
cted
to th
e ex
istin
g nu
rsin
g ho
me.
Reas
ons
to n
ot re
nova
te th
is b
uild
ing
incl
ude:
• Th
e bu
ildin
g is
muc
h la
rger
than
is w
arra
nted
by
the
prop
osed
ser
vice
s/de
part
men
ts•
The
exis
ting
build
ing
geom
etry
is ir
regu
lar (
espe
cial
ly o
n th
e gr
ound
floo
r),
and
the
loca
tion
of fi
re s
tairs
and
ele
vato
rs m
ake
the
build
ing
less
effi
cien
t in
layo
ut th
an c
ould
be
prov
ided
in n
ew c
onst
ruct
ion
• En
croa
chm
ent o
n th
e 10
0’ c
ritic
al b
uffer
are
a of
the
site
is a
ser
ious
dra
wba
ck•
Reno
vatio
n w
ill re
quire
d ph
asin
g of
con
stru
ctio
n in
side
a b
uild
ing
prov
idin
g cl
inic
al s
ervi
ces
24/7
. Fun
ds w
ill b
e ex
pend
ed o
n te
mpo
rary
con
stru
ctio
n pr
otec
tion
mea
sure
s an
d pa
tient
s an
d st
aff w
ill b
e ex
pose
d to
gre
ater
risk
s th
an if
con
stru
ctio
n of
a n
ew fa
cilit
y w
ere
unde
rtak
en o
utsi
de th
e w
alls
of t
he
exis
ting
faci
lity.
Te
st
Fit
La
yo
ut(
s)
A te
st fi
t was
cre
ated
to c
onfir
m th
e fe
asib
ility
of r
enov
atin
g th
e 19
80 B
uild
ing
(with
its
min
or a
dditi
ons)
to a
ccom
mod
ate
the
spac
e pr
ogra
m. T
he c
linic
al
prog
ram
s ca
n be
func
tiona
l on
the
first
floo
r with
min
or re
duct
ions
in s
pace
from
th
e sp
ace
prog
ram
. The
sec
ond
floor
of t
he b
uild
ing
coul
d ea
sily
acc
omm
odat
e ad
min
istr
ativ
e offi
ces,
staff
bre
ak ro
om, I
T/el
ectr
ical
equ
ipm
ent a
nd s
till h
ave
muc
h un
assi
gned
spa
ce th
at c
ould
be
use
for m
echa
nica
l equ
ipm
ent o
r any
oth
er
purp
ose
if de
sire
d.
The
test
fit w
as c
reat
ed m
eetin
g th
e 20
18 e
ditio
n of
the
FGI G
uide
lines
and
201
0 ed
ition
of t
he A
DA
. Dia
gram
s ar
e in
clud
ed in
the
appe
ndix
.
Arc
hit
ec
tura
l S
tra
teg
y
The
inte
rior o
f the
198
0 bu
ildin
g, b
oth
floor
s, w
ill b
e gu
tted
and
reco
nstr
ucte
d in
pha
ses
to p
rovi
de a
n effi
cien
t lay
out f
or th
e pr
opos
ed d
epar
tmen
ts. O
nce
com
plet
ed, t
he o
lder
por
tions
of t
he h
ospi
tal c
ompl
ex w
ill b
e de
mol
ishe
d.
The
nurs
ing
hom
e is
not
impa
cted
by
the
prop
osed
con
stru
ctio
n w
ork.
M.E
.P. S
tra
teg
y
Repl
acem
ent o
f the
exi
stin
g M
EP in
fras
truc
ture
will
be
com
plic
ated
and
ex
pens
ive
as c
linic
al d
epar
tmen
ts w
ill n
eed
to re
mai
n in
ope
ratio
n du
ring
the
reno
vatio
n pe
riod.
The
Em
erge
ncy
Dep
artm
ent i
s in
ope
ratio
n 24
/7, s
o re
plac
emen
t of i
nfra
stru
ctur
e su
ch a
s th
e m
ain
elec
tric
al s
yste
m w
ill n
eed
spec
ial
acco
mm
odat
ion.
Plea
se s
ee a
ttac
hed
list o
f M.E
.P. s
yste
ms
to b
e ad
dres
sed.
Ple
ase
note
that
re
plac
emen
t of e
xist
ing
infr
astr
uctu
re w
ill b
e m
ore
com
plic
ated
and
exp
ensi
ve
as c
linic
al d
epar
tmen
ts w
ill n
eed
to re
mai
n in
ope
ratio
n du
ring
the
reno
vatio
n pe
riod.
Esp
ecia
lly th
e Em
erge
ncy
Dep
artm
ent i
s in
ope
ratio
n 24
/7, s
o re
plac
emen
t of i
nfra
stru
ctur
e su
ch a
s th
e m
ain
elec
tric
al s
yste
m w
ill n
eed
spec
ial
acco
mm
odat
ion.
Esti
ma
ted
Co
nstr
uc
tio
n C
ost
Phas
ed re
nova
tion
of th
e fa
cilit
y w
hile
mai
ntai
ning
clin
ical
ope
ratio
ns w
ill e
qual
or
exce
ed th
e co
st o
f con
stru
ctio
n of
the
prop
osed
repl
acem
ent f
acili
ty.
Esti
ma
ted
Tim
e L
ine
Reno
vatio
n w
ill n
eed
to o
ccur
in a
t lea
st tw
o ph
ases
, with
som
e sh
ared
are
as (s
uch
as th
e m
ain
corr
idor
) kep
t in
full
oper
atio
n du
ring
the
entir
e re
nova
tion
perio
d.
CRTK
L| 1
1
List
of M
.E.P
. eng
inee
ring
issu
es to
be
addr
esse
d fo
r the
reno
vatio
n op
tion.
a.
Conv
ert a
ppro
xim
atel
y ha
lf of
the
2nd
floor
to b
e m
echa
nica
l/ele
ctric
al s
pace
.b.
Ex
pand
the
exis
ting
prop
ane
fuel
farm
on
the
site
to in
clud
e fo
ur (4
) add
ition
al 1
,000
ga
llon
tank
s. Ex
tend
a 3
” und
ergr
ound
pro
pane
ser
vice
pip
e ar
ound
the
Nur
sing
H
ome
and
site
to a
djac
ent t
o th
e ex
istin
g 2”
ser
vice
for t
he n
ursi
ng h
ome
(at t
he
load
ing
dock
). Ex
tend
the
new
3” s
ervi
ce to
the
exis
ting
cent
ral u
tility
pla
nt (C
UP)
.c.
Pr
ovid
e tw
o (2
) new
200
-ton
roof
top
air c
oole
d ch
iller
s on
the
roof
ove
r the
old
su
rger
y sp
ace.
Ext
end
pipi
ng in
to th
e ne
w 2
nd fl
oor M
EP s
pace
to n
ew d
istr
ibut
ion
pum
ps. E
xten
d an
d co
nnec
t new
chi
lled
wat
er p
ipin
g to
old
. Onc
e ne
w c
hille
r pla
nt
is a
ctiv
e, re
mov
e ex
istin
g ab
ando
ned
roof
top
AC
chi
ller l
ocat
ed a
bove
the
exis
ting
cent
ral p
lant
, and
all
asso
ciat
ed p
ipin
g, s
uppo
rts
and
conn
ectio
ns. D
emol
ish
any
chill
er p
umps
/spe
cial
ties
in th
e C
UP.
d.
Prov
ide
thre
e (3
) new
25
GPM
con
dens
ing
dom
estic
wat
er h
eate
rs in
the
exis
ting
CU
P, tw
o to
met
the
dem
and
with
one
redu
ndan
t hea
ter.
Hea
ters
will
be
prop
ane
fired
. Ext
end
and
conn
ect H
W p
ipin
g to
exi
stin
g. In
stal
l one
(1) n
ew h
eate
r in
the
spac
e ad
jace
nt to
the
exis
ting
1,20
0 ga
llon
tank
hea
ter.
Onc
e st
arte
d up
and
co
nnec
ted
to th
e ex
istin
g pi
ping
sys
tem
, dem
olis
h th
e ex
istin
g 1,
200
gallo
n ta
nk/
heat
er a
nd a
ssoc
iate
d eq
uipm
ent a
nd s
team
pip
ing.
Whe
n th
e sp
ace
is c
lear
ed, i
nsta
ll th
e re
mai
ning
two
(2) h
eate
rs in
the
old
tank
hea
ter f
ootp
rint.
e.
Prov
ide
a ne
w 1
0 G
PM d
omes
tic h
ot w
ater
reci
rcul
atio
n pu
mp
and
asso
ciat
ed p
ipin
g an
d sp
ecia
ltie
s in
the
CU
P. P
rovi
de a
cop
per-
silv
er L
egio
nella
trea
tmen
t sys
tem
.f.
Dem
olis
h on
e ex
istin
g hi
gh p
ress
ure
stea
m b
oile
r and
ass
ocia
ted
pipi
ng a
nd
spec
ialt
ies.
This
boi
ler i
s re
dund
ant c
apac
ity. P
rovi
de th
ree
(3) n
ew 1
,000
MG
H
cond
ensi
ng h
eatin
g ho
t wat
er b
oile
rs in
exi
stin
g bo
iler f
ootp
rint.
The
boile
rs w
ill b
e du
al fi
red
with
pro
pane
and
die
sel f
uel o
il. E
xten
d ne
w h
eatin
g ho
t wat
er p
ipin
g up
to
exis
ting
pent
hous
e to
bac
k fe
ed o
ld s
team
-to-
HW
con
vert
er s
yste
m, t
hen
dem
o ol
d co
nver
ters
and
ste
am s
tatio
n in
the
pent
hous
e.g.
O
nce
new
HH
W s
yste
m is
con
nect
ed, d
emol
ish
rem
aini
ng H
P st
eam
boi
ler,
deae
rato
r, pi
ping
, etc
.h.
Re
plac
e ex
istin
g m
edic
al v
acuu
m p
ump
with
new
ski
d/pa
ckag
ed d
ry c
law
sys
tem
.i.
Prov
ide
a m
edic
al a
ir m
anifo
ld s
yste
m in
the
CU
P (o
r a m
edic
al a
ir pu
mp)
, and
ex
tend
new
pip
ing
to th
e ED
, Tra
uma
Room
s an
d Is
olat
ion
Room
s as
requ
ired
by
prog
ram
min
g.j.
In th
e pe
ntho
use,
mak
e te
mpo
rary
con
nect
ions
bet
wee
n A
HU
-1 a
nd 2
. The
se a
re
dual
duc
t uni
ts. I
n th
e ho
spita
l, cl
ose
off a
ll du
al d
uct b
oxes
for u
nocc
upie
d ar
eas.
Then
, dem
olis
h ex
istin
g A
HU
-2. I
nsta
ll a
new
cus
tom
fiel
d-er
ecte
d A
HU
in
the
exis
ting
AH
U-2
foot
prin
t. Th
e A
HU
will
be
appr
oxim
atel
y 40
,000
CFM
, and
incl
ude
a fa
n ar
ray
for t
he s
uppl
y. O
nce
inst
alle
d, th
e ne
w A
HU
will
bac
k0fe
ed th
e A
HU
-1
syst
em. T
hen
dem
olis
h ex
istin
g A
HU
-1 a
nd A
HU
-3 (D
OA
S un
it se
rvin
g 2n
d flo
or
FCU
’s).
The
new
AH
U w
ill b
e si
ngle
duc
t usi
ng H
HW
for r
ehea
t at t
he V
AV b
oxes
. k.
Re
mov
e al
l exi
stin
g du
al d
uctw
ork,
mai
ns, b
ranc
hes
and
supp
orts
. Rem
ove
all
exis
ting
dual
duc
t air
term
inal
uni
ts a
nd lo
w p
ress
ure
duct
wor
k an
d ai
r dev
ices
. Pr
ovid
e al
l new
sin
gle
duct
sup
ply
air d
uctw
ork,
sin
gle
duct
VAV
box
es, a
nd h
eatin
g ho
t wat
er p
ipin
g sy
stem
. The
duc
twor
k re
plac
emen
t will
be
done
as
phas
ed
cons
truc
tion,
as
area
s on
the
first
floo
r will
rem
ain
occu
pied
dur
ing
the
repl
acem
ent.
l. Pr
ovid
e a
new
cen
tral
DD
C b
uild
ing
auto
mat
ion
syst
em.
m.
Repl
ace
exis
ting
6” c
ombi
ned
fire/
wat
er s
ervi
ce w
ith a
new
8”,
or in
clud
e a
new
pa
ralle
l 4” t
o he
lp a
llevi
ate
the
fire
pum
p ch
urn
issu
es.
n.
Prov
ide
new
fire
pum
p to
mai
ntai
n 10
0 ps
ig a
t top
of s
tand
pipe
s.o.
A
dd c
ritic
al e
xhau
st s
yste
ms
for i
sola
tion
room
s, ED
wai
ting
room
, tria
ge a
nd
radi
olog
y w
aitin
g ro
oms.
p.
Add
a d
edic
ated
dec
onta
min
atio
n sh
ower
exh
aust
sys
tem
per
cod
e.q.
Pr
ovid
e ne
w m
aste
r and
are
a m
edic
al g
as a
larm
pan
els
and
exte
nd to
BA
S.r.
Repl
ace
exis
ting
sani
tary
lift
sta
tion
serv
ing
the
hosp
ital,
nurs
ing
hom
e an
d 19
19
build
ings
.s.
Gen
erat
or A
cces
s. Th
e ge
nera
tor b
reak
er s
its a
bove
the
reco
mm
ende
d 6’
7” h
eigh
t for
op
erab
ility
per
NEC
. Gen
erat
or s
its o
n un
derb
elly
tank
, and
acc
ess
for m
aint
enan
ce
wou
ld b
e di
fficu
lt.
t. Pr
ovid
e ne
w 4
80Y/
277V
, 160
0A e
lect
rical
ser
vice
via
pad
mou
nted
tran
sfor
mer
on
site
.u.
Pr
ovid
e ne
w 4
80Y/
277V
, 160
0A S
witc
hboa
rd in
new
ele
ctric
al s
pace
on
2nd
floor
.v.
Mai
ntai
n ex
istin
g 75
0 K
W g
ener
ator
for e
mer
genc
y po
wer
.w
. Pr
ovid
e ne
w A
TS’s
to m
atch
exi
stin
g si
zes
in d
edic
ated
em
erge
ncy
pow
er d
istr
ibut
ion
room
on
the
2nd
floor
sep
arat
ed fr
om n
orm
al p
ower
. Pro
vide
repl
acem
ents
to m
ajor
em
erge
ncy
pow
er d
istr
ibut
ion
pane
ls im
med
iate
ly d
owns
trea
m o
f ATS
’s o
n th
is fl
oor
as w
ell.
This
wou
ld in
clud
e an
800
A e
quip
men
t bra
nch,
a 4
00A
crit
ical
bra
nch,
a 2
25A
ra
diol
ogy
bran
ch, a
nd a
100
A li
fe s
afet
y br
anch
. •
Ded
uct a
ltern
ate.
Mai
ntai
n ex
istin
g tr
ansf
er s
witc
hes
and
emer
genc
y di
strib
utio
n on
gro
und
floor
. Thi
s op
tion
leav
es e
mer
genc
y po
wer
sys
tem
vu
lner
able
to fl
oodi
ng.
Flo
or
Re
no
va
tio
ns
a.
Reno
vate
are
as o
f firs
t floo
r per
arc
hite
ctur
al p
rogr
am a
nd c
once
pt.
b.
In g
ener
al, a
ll sp
aces
will
be
gutt
ed d
own
to th
e st
ruct
ure
for c
ompl
ete
reno
vatio
n.
All
win
dow
s an
d ex
terio
r doo
rs w
ill b
e re
plac
ed.
c.
HVA
C s
yste
ms
for t
he re
nova
ted
spac
es w
ill in
clud
e ne
w s
uppl
y du
ctw
ork
mai
ns, V
AV
boxe
s, H
HW
pip
ing
and
cont
rols
.d.
Pl
umbi
ng d
istr
ibut
ion
(CW
/HW
/HW
R) p
ipin
g w
ill b
e al
l new
e.
Plum
bing
san
itary
/ven
t pip
ing
will
be
all n
ew. T
he fi
rst fl
oor i
s sl
ab o
n gr
ade
and
will
re
quire
ext
ensi
ve c
uttin
g an
d pa
tchi
ng o
f con
cret
e flo
ors
and
tren
chin
g.f.
All
exis
ting
elec
tric
al p
anel
s, fe
eder
s an
d br
anch
circ
uitin
g w
ill b
e re
plac
ed in
the
reno
vatio
n sp
aces
.g.
A
ll ex
istin
g lig
htin
g fix
ture
s an
d ci
rcui
ting
will
be
rem
oved
. Pro
vide
LED
ligh
ting
fixtu
res
thro
ugho
ut a
reas
of r
enov
atio
n in
acc
orda
nce
with
IES
stan
dard
s.h.
A
ll ex
istin
g fir
e al
arm
dev
ices
and
wiri
ng w
ill b
e re
mov
ed. E
xten
d ex
istin
g fir
e al
arm
sy
stem
with
new
initi
atio
n an
d no
tifica
tion
appl
ianc
es th
roug
hout
reno
vate
d sp
ace.
Ce
ntr
al
Pla
nt/
Ce
ntr
al
ME
P S
yste
ms
12
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
3.E
OP
TIO
N 3
: N
EW
CO
NS
TR
UC
TIO
N/R
EP
LA
CE
ME
NT
Re
co
mm
en
de
d S
ite
/ L
oc
ati
on
A n
ew fr
eest
andi
ng F
MF
of a
ppro
xim
atel
y 25
,000
BG
SF is
pro
pose
d to
be
cons
truc
ted
east
of t
he e
xist
ing
1980
Bui
ldin
g w
ith d
irect
con
nect
ion
to th
e do
or
at th
e so
uthw
est c
orne
r of t
he n
ursi
ng h
ome.
The
FM
F w
ould
be
clea
r of t
he 1
00’
criti
cal a
rea
buff
er, a
nd e
ssen
tially
be
on th
e ho
spita
l par
king
lot.
The
mai
n flo
or
leve
l wou
ld m
atch
the
leve
l of t
he n
ursi
ng h
ome
at 1
0’-6
”.
Occ
upie
d sp
aces
wou
ld b
e on
the
first
floo
r of t
he b
uild
ing.
An
uppe
r lev
el w
ould
be
con
stru
cted
for s
elec
ted
mec
hani
cal e
quip
men
t, bu
t esp
ecia
lly fo
r ele
ctric
al
and
IT e
quip
men
t.
Onc
e th
e ne
w F
MF
is o
pene
d, th
e ex
istin
g ho
spita
l bui
ldin
gs w
ould
be
dem
olis
hed.
A
new
par
king
lot f
or th
e FM
F co
uld
be c
onst
ruct
ed in
the
100’
crit
ical
are
a bu
ffer
an
d/or
on
the
land
vac
ated
by
the
dem
olis
hed
hosp
ital b
uild
ings
.
Te
st
Fit
La
yo
ut
A s
impl
e bu
ildin
g is
pro
pose
d fo
r the
FM
F. A
mai
n en
tran
ce lo
bby
wou
ld s
erve
th
e E.
D.,
a cl
inic
and
the
imag
ing/
lab
diag
nost
ic a
reas
. The
clin
ic w
ould
con
nect
to
the
E.D
. so
staff
, equ
ipm
ent a
nd p
atie
nt tr
eatm
ent a
reas
cou
ld b
e sh
ared
as
appr
opria
te. T
he im
agin
g/la
b ar
ea is
ver
y ne
ar th
e E.
D. a
nd c
linic
sin
ce th
ose
depa
rtm
ents
will
refe
r pat
ient
s fo
r dia
gnos
tic s
ervi
ces.
An
ambu
lanc
e en
tran
ce
is p
ropo
sed
to b
e lo
cate
d ar
ound
the
corn
er fr
om th
e m
ain
entr
ance
to p
rovi
de
priv
acy
for t
hose
pat
ient
s tr
ansp
orte
d by
am
bula
nce,
yet
the
rece
ptio
n/tr
iage
ar
eas
of th
e E.
D. s
houl
d be
con
veni
ent t
o bo
th e
ntra
nces
.
Sepa
rate
ent
ranc
es a
re p
ropo
sed
for t
he o
utpa
tient
beh
avio
ral h
ealt
h an
d th
e ou
tpat
ient
reha
bilit
atio
n su
ites.
In b
oth
thes
e ca
ses,
patie
nts
com
e fr
eque
ntly
an
d re
peat
edly
for t
he s
essi
ons
in th
eir t
reat
men
t pla
ns. T
he b
ehav
iora
l hea
lth
patie
nts
wou
ld p
refe
r priv
acy
as th
ey c
ome
to th
e FM
F; th
e re
habi
litat
ion
patie
nts
will
ben
efit f
rom
min
imal
wal
king
dis
tanc
e be
twee
n th
eir c
ars
and
the
FMF.
A s
ervi
ce e
ntra
nce
with
an
8’ w
ide
encl
osed
cor
ridor
to th
e nu
rsin
g ho
me
will
al
low
for p
atie
nts
and
serv
ices
to e
asily
mov
e ba
ck a
nd fo
rth
betw
een
the
two
faci
litie
s. Th
e FM
F w
ill b
e sm
all e
noug
h to
not
requ
ire a
form
al lo
adin
g do
ck, a
do
uble
doo
r at t
his
loca
tion
will
suffi
ce fo
r the
del
iver
ies.
An
outd
oor s
cree
ned
area
will
be
crea
ted
for t
he v
ario
us w
aste
ser
vice
s.
Arc
hit
ec
tura
l S
tra
teg
y
The
new
FM
F w
ill b
e co
nstr
ucte
d as
a s
ingl
e-st
ory
faci
lity
for a
ll th
e cl
inic
al a
reas
to
max
imiz
e fle
xibi
lity
of c
linic
al s
ervi
ces.
It is
pro
pose
d to
be
loca
ted
next
to th
e nu
rsin
g ho
me
so it
has
an
adeq
uate
con
stru
ctio
n si
te w
hile
the
exis
ting
hosp
ital
rem
ains
in o
pera
tion.
The
nur
sing
hom
e’s
mai
n en
tran
ce in
clud
es a
long
ext
erio
r ra
mp,
whi
ch th
e ne
w F
MF
will
dem
olis
h. T
he p
ropo
sed
mai
n en
tran
ce to
the
FMF
wou
ld b
e sh
ared
with
the
nurs
ing
hom
e to
pro
vide
one
gra
ciou
s en
tran
ce to
ser
ve
both
faci
litie
s.
Ther
e w
ill a
lso
be a
n in
terio
r con
nect
ion
betw
een
the
FMF
and
the
serv
ice
corr
idor
of t
he n
ursi
ng h
ome
that
lead
s ba
ck to
the
load
ing
dock
.
Entr
ance
s to
the
FMF
will
be
cons
olid
ated
into
two
loca
tions
: the
join
t FM
F/nu
rsin
g ho
me
entr
ance
and
the
ED/O
utpa
tient
Psy
ch e
ntra
nce.
In b
oth
case
s, th
e ex
terio
r gra
de le
vel w
ill s
lope
gen
tly
up to
the
floor
leve
l of t
he F
MF
and
nurs
ing
hom
e. T
his
also
hel
ps s
epar
ate
a “f
ront
” sid
e of
the
FMF
from
a “p
rivat
e” s
ide.
Th
e “f
ront
” mai
n lo
bby
of th
e FM
F w
ill s
erve
the
follo
win
g:
• C
risfie
ld C
linic
• La
bora
tory
• Im
agin
g•
Out
patie
nt R
ehab
• A
dmin
istr
atio
n an
d se
rvic
e ar
eas
The
“bac
k” e
ntra
nce
area
will
hav
e vi
sual
scr
eeni
ng—
to b
e de
term
ined
in th
e de
sign
pha
se—
to p
rovi
de p
rivac
y be
twee
n th
e w
alk-
in e
ntra
nce
to th
e ED
, the
am
bula
nce
entr
ance
to th
e ED
, and
the
patie
nt e
ntra
nce
to th
e O
utpa
tient
Psy
ch
faci
lity.
The
ED, C
risfie
ld C
linic
, Lab
orat
ory
and
Imag
ing
depa
rtm
ents
are
des
igne
d as
one
bl
ock
that
can
sha
re s
taff
and
equ
ipm
ent,
and
allo
w p
atie
nt fl
ow o
ut o
f the
vie
w o
f pu
blic
spa
ces.
The
adm
inis
trat
ion
and
serv
ice
area
s (in
clud
ing
staff
sup
port
are
as) c
onne
ct th
e lo
bby
of th
e FM
F w
ith th
e se
rvic
e co
rrid
or o
f the
nur
sing
hom
e. T
he e
xist
ing
ram
p fr
om th
e ho
spita
l to
the
nurs
ing
hom
e ca
n be
re-p
urpo
sed
into
a s
taff
ent
ranc
e fo
r bot
h th
e FM
F an
d th
e nu
rsin
g ho
me.
CRTK
L| 1
3
Floo
r pla
n di
agra
m s
how
ing
prop
osed
loca
tions
of d
epar
tmen
ts in
the
FMF
and
rela
tions
hip
of th
e de
part
men
ts to
the
nurs
ing
hom
e.
14
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
Site
pla
n sh
owin
g th
e lo
catio
n of
the
prop
osed
FM
F in
blu
e. T
he F
MF
can
be c
onst
ruct
ed
whi
le th
e ex
istin
g ho
spita
l and
nur
sing
hom
e re
mai
n in
full
oper
atio
n.
M.E
.P. S
tra
teg
y
MEP
sys
tem
s fo
r the
new
PR
HS
FMF
will
be
sim
ilar t
o a
sim
ilar
near
by s
tand
alon
e ED
. The
se s
yste
ms
will
be
desc
ribed
in m
ore
deta
il as
the
conc
ept i
s fu
rthe
r dev
elop
ed.
Onc
e th
e ne
w b
uild
ing
is c
onst
ruct
ed a
nd s
taff
hav
e m
oved
ove
r, th
e ex
istin
g ho
spita
l and
cen
tral
pla
nt w
ill b
e de
mol
ishe
d.A
det
aile
d de
scrip
tion
of th
e M
EP s
yste
ms
is in
clud
ed in
the
appe
ndix
.
CRTK
L| 1
5
Site
pla
n sh
owin
g th
e ne
w F
MF
and
the
nurs
ing
hom
e af
ter t
he e
xist
ing
hosp
ital b
uild
ings
hav
e be
en d
emol
ishe
d.
Esti
ma
ted
Co
nstr
uc
tio
n C
ost
The
Whi
ting-
Turn
er C
onst
ruct
ion
Com
pany
cre
ated
a c
ost
estim
ate
for t
he p
ropo
sed
new
faci
lity
base
d on
the
spac
e pr
ogra
m a
nd re
cent
com
para
ble
cons
truc
tion
proj
ects
. The
pr
opos
ed re
plac
emen
t wou
ld h
ave
a co
nstr
uctio
n co
st o
f ap
prox
imat
ely
$14
mill
ion.
Not
e th
at th
e pr
ojec
t cos
t will
be
grea
ter.
See
App
endi
x fo
r add
ition
al d
etai
l.
Esti
ma
ted
Tim
e L
ine
App
roxi
mat
ely
2 ye
ars.
This
incl
udes
9 m
onth
s fo
r des
ign
(see
at
tach
ed s
ched
ule)
, abo
ut 1
3 m
onth
s to
con
stru
ct, a
few
mor
e m
onth
s fo
r com
mis
sion
ing,
tran
sitio
ning
to th
e ne
w fa
cilit
y, ce
rtifi
catio
ns, e
tc.
RE
CO
MM
EN
DA
TIO
N
Se
cti
on
4:
CR
TKL
| 1
6
OU
R R
EC
OM
ME
ND
AT
ION
Ra
tio
na
le f
or
Re
co
mm
en
da
tio
n
Cons
truc
tion
of a
new
bui
ldin
g is
our
sol
e re
com
men
datio
n fo
r the
fo
llow
ing
reas
ons:
• Th
e m
ain
floor
of t
he e
xist
ing
1980
bui
ldin
g is
too
low
abo
ve s
ea le
vel;
the
nurs
ing
hom
e is
18”
hig
her.
Ther
e is
risk
of fl
oodi
ng o
f the
hos
pita
l mai
n flo
or
leve
l.
• Pa
rt o
f the
198
0 bu
ildin
g is
with
in th
e 10
0’ c
ritic
al b
uffer
are
a, i.
e. it
is to
o cl
ose
to th
e w
ater
. The
re is
risk
of fl
oodi
ng.
• M
aint
enan
ce c
osts
of a
reno
vate
d bu
ildin
g w
ill b
e hi
gher
bec
ause
the
build
ing
has
alm
ost t
wic
e th
e ar
ea re
quire
d fo
r the
FM
F. It
will
be
nece
ssar
y to
kee
p th
e ex
tra
inte
rior s
pace
free
of m
old
and
verm
in, t
he e
xtra
ext
erio
r wal
ls/w
indo
ws/
door
s w
ill n
eed
to b
e m
aint
aine
d an
d ke
pt w
eath
er ti
ght.
• G
eom
etry
of t
he e
xist
ing
build
ing:
the
exte
rior w
all o
f the
bui
ldin
g is
qui
te
irreg
ular
, thi
s lim
its th
e ge
omet
ry o
f pot
entia
l int
erio
r lay
outs
. Fill
ing
in th
e ga
ps b
etw
een
the
exte
rior p
ortio
ns w
ould
be
expe
nsiv
e an
d cr
eate
pro
blem
s w
ith th
e flo
or s
lab
join
ts.
• Th
e ge
omet
ry o
f the
exi
stin
g bu
ildin
g (lo
catio
n of
fire
sta
irs, e
leva
tors
an
d eg
ress
requ
irem
ents
) for
ces
the
reno
vatio
n la
yout
to b
e in
effici
ent.
Dep
artm
ents
and
cor
ridor
s m
ust “
snak
e ar
ound
” the
fixe
d el
emen
ts; s
ome
port
ions
of t
he b
uild
ing
inte
rior (
for e
xam
ple,
the
chap
el a
rea)
are
long
and
sk
inny
and
diffi
cult
to a
cces
s.
• Th
e flo
or s
lab
on th
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ain
floor
is re
port
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be
slab
-on-
grad
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his
will
re
quire
dem
olis
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por
tions
of t
he fl
oor s
lab
to a
dd n
ew u
nder
-floo
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requ
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for t
he p
ropo
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clin
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func
tions
. Thi
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re
nova
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is a
n in
fect
ion
cont
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isk,
and
mak
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mor
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to h
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ooth
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the
final
reno
vate
d sp
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ust b
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herm
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re o
n th
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ain
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whe
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part
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houl
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loca
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afte
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ovat
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optio
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to re
loca
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epar
tmen
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t of t
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utda
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astr
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reno
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enefi
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ct—
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par
titio
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ir fil
ters
, tes
ting
to c
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at th
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k m
itiga
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stra
tegi
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rea
effec
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• Th
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ound
floo
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980
build
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(with
sm
all a
dditi
ons)
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o sm
all
to a
ccom
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all t
he c
linic
al d
epar
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ts a
s cu
rren
tly
prog
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med
. A
ppro
xim
atel
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% o
f the
spa
ces
can
be a
ccom
mod
ated
, so
it co
uld
be
func
tiona
l, bu
t it i
s st
ill u
nfor
tuna
te to
com
prom
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the
initi
al la
yout
. Thi
s w
ill
hind
er fu
ture
func
tiona
lity
as n
ew e
quip
men
t, tr
eatm
ents
and
pro
toco
ls w
ill
typi
cally
ben
efit f
rom
“flex
” spa
ce, a
litt
le e
xtra
spa
ce to
han
dle
new
item
s.
• Co
nstr
uctio
n co
st to
reno
vate
the
1980
Bui
ldin
g is
like
ly to
equ
al o
r exc
eed
the
cost
of n
ew c
onst
ruct
ion,
and
reno
vatio
n co
sts
will
be
mor
e di
fficu
lt to
m
anag
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exi
stin
g co
nditi
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will
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dete
rmin
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urin
g th
e co
nstr
uctio
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oces
s.
• Th
e du
ratio
n of
con
stru
ctio
n ac
tiviti
es is
like
ly to
be
grea
ter i
n re
nova
tion
than
in
new
con
stru
ctio
n be
caus
e re
nova
tion
will
ent
ail p
hase
s of
con
stru
ctio
n.
• A
new
bui
ldin
g ca
n po
rtra
y a
stat
e-of
-the
-art
pro
fess
iona
l env
ironm
ent o
f car
e th
at c
anno
t be
pres
ente
d by
a 4
0-ye
ar o
ld e
xter
ior.
Add
ition
al fu
nds
wou
ld b
e re
quire
d to
upd
ate
the
exte
rior i
mag
e of
the
faci
lity.
A n
ewly
con
stru
cted
Fre
esta
ndin
g M
edic
al F
acili
ty is
the
best
opt
ion
to p
rovi
de
heal
th c
are
serv
ices
to th
e C
risfie
ld c
omm
unity
in a
cos
t-eff
ectiv
e m
anne
r.
17
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
Co
st
Esti
ma
te
The
cost
of t
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tal p
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clud
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ompo
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s:
Co
nstr
uc
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n C
ost
The
larg
est i
s th
e co
nstr
uctio
n co
st, w
hich
was
est
imat
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ased
on
the
spac
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ther
cos
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emiz
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elow
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Co
nti
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Fu
nd
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or
Inte
rim
Ma
inte
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phys
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ill n
eed
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aint
aine
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til a
repl
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as
been
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reno
vate
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aces
. Thi
s co
uld
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ly e
xten
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coup
le y
ears
into
the
futu
re,
depe
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app
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ls fr
om s
tate
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loca
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iabl
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infr
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cally
bey
ond
its u
sefu
l life
and
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bee
n m
aint
aine
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a
limite
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dget
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whe
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nee
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edia
tely
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cilit
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pica
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cks
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A s
igni
fican
t con
tinge
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fund
is s
tron
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reco
mm
ende
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Pro
fessio
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Des
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fees
for t
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Med
ical
Fac
ility
are
est
imat
ed to
be
appr
oxim
atel
y $1
,200
,000
. Th
is fe
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incl
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reim
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s (t
rave
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intin
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tc.).
For
mor
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taile
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form
atio
n on
des
ign
fees
(inc
lusi
ons,
excl
usio
ns, r
efer
to th
e ap
pend
ix o
f thi
s re
port
.
This
est
imat
e is
bas
ed o
n th
e cu
rren
t des
ign
conc
ept a
nd s
ched
ule
as p
rese
nted
in
this
repo
rt.
It in
clud
es fu
ll de
sign
ser
vice
s fo
r Arc
hite
ctur
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terio
r Des
ign,
M
edic
al P
lann
ing,
MEP
Eng
inee
ring,
Str
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ngin
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ivil
Engi
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W
ayfin
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and
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nage
, Geo
tech
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ring
as w
ell a
s an
exi
stin
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nditi
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surv
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cope
of w
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incl
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all
desi
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s: C
once
pt
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Sch
emat
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esig
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evel
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truc
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truc
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Serv
ices
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w M
ed
ica
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qu
ipm
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t /
Fu
rnis
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gs
Serv
ices
to b
e pr
ovid
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y PR
MC
.
Re
loc
ati
on
/ T
ran
sit
ion
Co
sts
Serv
ices
to b
e pr
ovid
ed b
y PR
MC
.
Oth
er
Co
sts
Secu
rity
Syst
ems –
Vid
eo S
urve
illan
ce a
nd A
cces
s Co
ntro
l: $2
00,0
00
CRTK
L| 1
8
Sum
mar
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con
stru
ctio
n co
st e
stim
ate
19
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
De
tail
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Tim
e L
ine
s
Mc
Cre
ad
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ran
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ch
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01
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esig
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ing
Tim
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e en
tire
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ect s
ched
ule
to o
pen
an F
MF
in C
risfie
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ased
on
July
1, 2
019
star
t dat
e.
CRTK
L| 2
0
Mc
Cre
ad
y T
ran
sit
ion
Pro
jec
t S
ch
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Ba
se
d o
n E
arl
y D
esig
n &
Pro
gra
mm
ing
Tim
elin
e sh
owin
g th
e en
tire
proj
ect s
ched
ule
to o
pen
an F
MF
in C
risfie
ld b
ased
on
Nov
embe
r 1, 2
018
star
t dat
e.
21
| R
epor
t on
McC
read
y M
emor
ial H
ospi
tal
Tim
elin
e fo
r the
des
ign
serv
ices
for a
n FM
F.
September 13, 2018
Existing Areas Diagram
Existing Areas
Existing Floor Plans
Existing Floor Plans
Site Plan
PENINSULA REGIONAL MEDICAL CENTER
McCready Memorial Hospital ReplacementJuly 24, 2018
SUMMARY PAGE Proposed Area is based on input freceived from July 23 site visit and August 8 PRMC meeting
Existing
Department DGSF NSF DGSF BGSF
Staff per
ShiftTotal Staff
Staffno
lockersDGSF
Floor 1DGSF
Floor 2DGSFEither
ADMINISTRATION 1,175 1,586 10.6 10.60 6.00 1,586CRISFIELD CLINIC 1,965 2,751 10 9.80 9.80 2,751FREESTANDING E. D. 2,640 3,705 5,557 8 26.86 26.86 5,557IMAGING 3,324 1,562 2,343 3.5 6.43 2,343LABORATORY 1,267 1,014 1,267 2 5.95 1,267PHARMACY 1,460 0 0 1 1.10PSYCH--OUTPATIENT 1,500 880 1,346 3 3.00 3.00 1,346PHYSICAL THERAPY 4,624 2,308 3,000 4.2 4.20 3,000SUPPORT SERVICES 1,892 2,460 7 15.38 861 780 819
Subtotals: 14,501 20,311 49 83.32 45.66 13,028 780 6,503
COMM/LAN CLOSETS in DGSf check 20,311COMMON CIRCULATION 1,625 8.0%MEP ALLOWANCE 658 3.0% Elec in SupportBUILDING ENVELOPE 752 minimum
23,345
Elev/Fire Stairs if 2nd floor 900
ESTIMATED TOTAL BGSF 24,245
Proposed Possible Locations
Space Program
Phase One Level One
Phase One Level Two
The option to renovate the 1980 Building for a Freestanding Medical Center was studied but is not recommended. These pages show the proposed option that appeared to be most promising.
Phase Two Level One
Phase Two Level Two
Final Layout Level One
This plan shows the final layout for the main floor level.
A. COOLING
The peak chilled water load is estimated to be 125 tons for the proposed facility.
The system will consist of two (2) 150 ton air-cooled chillers (de-rated to 125 ton for glycol), located on the roof, and will utilize a minimum 30% propylene glycol mixture to prevent freezing. One unit will serve the cooling loads while the second will provide redundant capacity.
The base load chiller will be provided with a free-cooling coil and valve arrangement to take advantage of winter ambient temperatures when cooling is required in the building.
The chillers will be designed with a 14°F differential, 56°F entering water/glycol temperature and 42°F leaving temperature. The condenser sections will be rated for a 100°F ambient temperature to compensate for higher rooftop temperatures. The evaporator coils will be coated for coastal environments. The chilled water system will be a variable flow primary arrangement.
Pumps and Piping Systems:
Two (2), 250 GPM pumps will be provided in a rooftop mechanical room for the chilled water system. One will provide chilled water to the building AHU’s and the second will act as a redundant pump. A single buffer tank, air separator, and expansion tank will also be located in the mechanical room. The chillers will be piped together in a parallel arrangement with automatic isolation valves.
Any piping exposed on the roof will include fiberglass insulation and metal jacketing. Chilled water piping located on the roof shall be black steel or type K copper.
Chemical Treatment:
Chemical treatment systems will be installed to serve the chilled water systems. The chemical treatment will comprise of combination filtration/shot feeders. These will be located in the main mechanical room.
B. HEATING
The heating load is estimated to be 1,000 MBH for the proposed facility.
The boilers will consist of two propane gas fired, 1,000 MBH output boilers with the ability to operate on fuel oil as a backup fuel. The system requires “firm” redundancy per code requirements to ensure heating in the event of a boiler failure. The fuel oil will act as an emergency heating back-up in the event that propane service is interrupted. The boilers will be piped in a parallel arrangement with isolation valves. The system will be designed with a 40°F differential, 100°F entering water temperature and 140°F leaving water temperature.
The heating water system will be a primary/secondary loop arrangement within the mechanical room. A single, primary heating water pump will be provided for each boiler. The primary boiler pumps will be in-line type pumps. Two (2), 80 GPM secondary heating water pumps will circulate the water to the building. A variable frequency drive will be provided for all secondary pumps to allow a reduction in pumping energy during varying load conditions. Heating water piping shall be black steel or type K copper.
Chemical Treatment:
A chemical treatment system will be installed to serve the heating water system. The chemical treatment will comprise of filtration and shot feeders. A separate vendor, obtained by the owner, will be responsible for all chemicals, chemical tanks, and injection pumps.The plant will be complete with air separators, expansions tanks, by-pass valves, solid separators, and control devices.
C. AIR HANDLING SYSTEMS
A summary of the air handling units is listed below:AHU # Capacity (CFM) % Minimum OA AHU-1 25,000 35 AHU-2 25,000 35 All air handling units will be located on the roof on 24” high roof curbs and will be connected in parallel to the ductwork systems. To accommodate current energy codes, a plate type total enthalpy heat recovery unit will be provided on the roof to preheat/precool the outside air feeding the AHU’s from the exhaust air system.Air handling units 1 and 2 will be semi-custom, double-wall, aluminum rooftop modular units and will be equipped with the following:
• Supply: 6 fan array (N+1 redundancy)• Return: 4 fan array (N+1 redundancy)• Pre/Intermediate filter (MERV 8/10) section• Hot water preheat coil section• Chilled water/glycol cooling coil section• UV lights• 95% (MERV 14) final filters• Steam humidifier• “Doghouse” with access doors to house maintainable
items (pumps, valves , etc)
MEP Systems Proposed for a New Freestanding Medical Facility
D. AIR DISTRIBUTION
All duct systems will be designed at low velocities to minimize overall static pressure loss and reduce fan horsepower to comply with building energy codes.
In general, medium pressure supply and return ducts will be routed into the ceiling space where it will be distributed horizontally to variable air volume supply air terminal units. Each supply air terminal unit will be equipped with hot water reheat to provide individual zone control. Return / exhaust air terminal units will be matched with supply air terminal unit(s) for critical pressurization spaces such as resuscitation/trauma rooms and isolation rooms.
All terminal units provided will be digital boxes with electronic actuation. Support spaces will be zoned together as their space load density warrants, as indicated on drawings. Low pressure ductwork will be extended from the terminal units to new air devices in the ceilings. Generally, aluminum louvered ceiling diffusers with 24”x24” lay-in modules and return / exhaust air registers will be used in treatment and support spaces. Critical spaces will be provided with specialty diffusers as appropriate for the purpose.
E. EXHAUST SYSTEMS
There will be a central general exhaust system, included as part of the energy recovery unit. There will also be two critical exhaust systems to serve isolation rooms and the decontamination shower rooms.
General
General exhaust systems will be provided throughout the facility to serve areas such as toilet rooms and soiled utility rooms.
Critical Exhaust
An exhaust air system will be required for the Airborne Infectious Isolation Rooms, ED Triage, ED Waiting Rooms and Lab. The exhaust air system will consist of two (2) high-plume, direct-drive fans, similar to a Greenheck Vektor MH, discharging a minimum of 10 feet above roof. The system will be fully redundant with two (2) fans on a common plenum. Under normal operation one fan will operate to meet the load. If a fan fails, the second fan will start. Fan speed will be controlled though variable frequency drives.
Medium pressure isolation exhaust air ductwork will be provided to the isolation rooms. Exhaust air terminal units will be provided to maintain negative pressure to each isolation exhaust room. In addition, isolation rooms will be provided with a room pressurization monitor at the isolation room which will be interlocked with the rooms supply and exhaust air terminal units via the building automation system.
Mechanical Room
There will be one (1) spun aluminum, centrifugal down blast domed exhaust fan serving the mechanical room, located on the roof above. This fan will be energized to ventilate the room to maintain the thermostat setpoint. A backdraft damper and louver located in the exterior wall, or roof, will allow for make-up air.
Decontamination
A dedicated critical exhaust air system will be required for the Decontamination room. The exhaust air system will consist of a high-plume type, direct-drive fan, similar to a Greenheck Vektor MH, discharging a minimum of 10 feet above roof per code. The systems will be fully redundant with two (2) fans on a common plenum. Under normal operation one fan will operate to meet the load. If a fan fails, the second fan will start. Fan speed will be controlled though variable frequency drives.
A medium pressure critical exhaust air duct will be provided to the decontamination room. The exhaust fan will maintain negative pressure in the decontamination room. In addition, the decontamination room will be provided with a room pressurization monitor at the decontamination room which will be interlocked with the rooms supply air terminal unit and fan via the building automation system.
F. HUMIDIFICATION
An atmospheric pressure propane fired steam generator will be installed on the roof to serve the air handling unit humidifiers. The humidifiers will be sized to maintain a minimum of 30% relative humidity within the occupied spaces during the winter months. Humidifier piping shall be stainless steel, insulated per energy code.
G. IT CLOSET / IMAGING EQUIPMENT ROOMS
The IT closets and electrical closets throughout the facility will have constant cooling requirements. A ductless split DX cooling system will be indicated to serve each IT closet and imaging equipment rooms with overhead air terminals serving as back-up cooling and to provide positive pressure per code. Electrical rooms containing transformers will be served by air terminal units without reheat coils. The air-cooled chillers will be operated year-round to maintain cooling in interior rooms.
H. PLUMBING SYSTEMS
The facility will be provided with the following plumbing systems:• Domestic cold water, hot water, and hot water
recirculation systems for all plumbing fixtures and equipment as required. Dead legs on domestic hot water piping will be reduced to be as short as practically possible.
• Domestic cold-water piping to freeze-proof hose bibs located along the exterior of the building (assume 6).
• Domestic cold water to irrigation systems and exterior water features. The irrigation service will tie into the system prior to the water softener system. An RPZ backflow preventer will be installed to protect the potable water system in the building. This system will be able to be isolated from the domestic water system when needed (valved off during winter months and freeze protected).
• Soil, waste and vent systems for all plumbing fixtures, drains, and equipment as required
• Water closets will generally be floor mounted, floor discharge, but some will be rear discharge to coordinate with structural members.
• Sinks and showers will include local thermostatic tempering valves per code.
• Public toilets and lavatories will utilize infra-red technology with hard-wired transformers.
• Medical gases will be provided to meet the code requirements
• Ball valves will be provided throughout all piping systems to isolate all equipment, and main branches where appropriate. Specifications will include required valve charting, numbered and identified accordingly, as a contractor responsibility.
All equipment and piping systems will be identified using labels and nameplates.
A single 8” combined fire and domestic water service will enter the facility, in a water room, which will immediately branch to the fire pump, and to the domestic water booster pump. Consideration should be made to include a second water service, however, there is only one service from the utility crossing the bridge to the site. In lieu of a second service, an emergency water connection could be considered, to allow serving the hospital from a tanker truck, through the booster pump. Two RPZ backflow preventers will be provided for domestic service and two RPZ backflow preventers will be provided for fire service, as indicated on drawings.
The system will be provided with a whole building water softener system. The system will include a brine tank as well as three resin tanks to reduce the mineral content from entering the building from the municipal supply.
The domestic hot water system will consist of two (2), 349 GPH, natural gas-fired water heaters with integral 119-gallon storage tanks. One unit will serve the load while the other will be redundant capacity. Water will be stored at 140°F and distribute to the facility. Thermostatic mixing valves will be located at each fixture to reduce the fixture discharge temperature to 110°F.
The system will be provided with a recirculation pump to recirculate the domestic hot water. The domestic hot water recirculation system will be designed in accordance with the International Plumbing Code. Temperature dependent balancing valves will be utilized throughout the recirculation system similar to Circuit Solver by ThermOmegaTech. Pump speed will be controlled through a differential pressure transmitter.
Domestic hot, cold, and recirculation piping 3” and smaller shall be soldered copper or Propress. Piping larger than 3” shall be galvanized steel using Victaulic couplings. All piping shall be insulated per code.
A mono-chloramine injection system will be utilized for domestic hot water sterilization.
All sanitary collected from the plumbing fixtures will be piped together below slab to several sanitary mains extended to 5’ outside the building to be extended by the civil division. Under-slab piping shall be cast iron soil pipe. All piping will be sized per International Plumbing Code requirements. Any food prep sanitary services will be routed through a grease trap. Exact points of connection and routing for the sanitary piping systems will be coordinated with the Civil Engineer during design.
Storm water collected from the roof drains will be collected and tied into the storm water service. Under-slab piping shall be cast iron soil pipe. Secondary storm drainage will be provided via roof scuppers. Exact points of connection and routing for the storm water will be coordinated with the Civil Engineer during design.
Foundation drains will be provided around the perimeter of the facility as directed by the structural division and piped into the storm water main on site.
I. MEDICAL GAS SYSTEMS
The facility will require medical gas/vacuum services. The services will include oxygen, medical air, and, vacuum. The mechanical room will house the medical air, and medical vacuum systems. The existing Praxair bulk oxygen system on site will remain to serve the new building.
The medical air compressor will be a triplex unit, with 10 hp oil-less scroll compressors and a capacity of 69.6 scfm @ 50 psi. The compressors are skid mounted with a 200 gallon receiver. Basis of design is a Beacon Medaes SAS10T.The vacuum pump will be a triplex unit, with 7.5 hp oil-less claw-type pumps and a capacity of 130 scfm @ 19” Hg of vacuum. The pumps are skid mounted with a 200 gallon receiver. Basis of design is a Beacon Medaes VHS07T.Lockable valves will be provided as recommended in NFPA 99 to facilitate future modifications to the medical gas/vacuum systems. In general, service valves will be provided upstream of each zone valve box. In addition, alarms will be provided as required in NFPA 99. This includes a minimum of two separate master alarm panels and all local alarming of zone valve boxes. Zone valve boxes will be provided at each separate patient zone (assume nine).
Medical gases and vacuum systems will be provided and designed in accordance with NFPA 99 and FGI Standards and Guidelines. All wall-mounted medical gas connections will be Diamond Quick-Connect type.
A summary of the FGI required medical gas outlets for each space is indicated in the chart below:
J. AUTOMATIC TEMPERATURE CONTROLS
A direct digital control (DDC) building automation system will be provided to monitor the facilities mechanical and plumbing systems. The system will be complete with operator’s workstations and all components required for a complete system. The system will include color graphics for each system with real-time monitoring and all software required to provide the control package. The workstations shall consist of a color monitor, PC, and printer. The system will be fully integrated with the fire alarm and security systems through the building’s IS Ethernet system for communication between control units.The following items will require monitoring through the building automation system:• Chilled Water System: complete system control and
monitoring• Heating Water System: complete system control and
monitoring• AHU’s: digital control with electronic actuation;
interface of status and monitoring• Domestic Hot Water System: complete system control
and monitoring • Isolation and General Exhaust Fans: interface of status
and monitoring• Air Measuring Devices: interface of status and
monitoring• Emergency Generator system• Normal power gear monitoring• Supply Air terminal Units: digital control and electronic
actuation• Return Air Terminal Units: digital control and electronic
actuation• Exhaust Air Terminal Units: digital control and
electronic actuation • Isolation Rooms: direct user interface for each
individual room• A full graphical interface for all systems at the BAS
operator workstation.
All controllers will be DDC and electronic. All controls and monitoring shall be able to be viewed via the web or cloud based services at the main PRMC campus in Salisbury, MD.
K. POWER DISTRIBUTION SYSTEMS
Normal Power
The local electrical utility will terminate their 13.2KV service feeder at a utility-owned pad-mount transformer on site. The utility service from the transformer will supply a 2000A, 480Y/277V Main Switchboard located in the building via a concrete encased duct-bank. This switchboard will contain four circuit breakers that feed the buildings automatic transfer switches.
Emergency Power
GeneratorsThe emergency generator will be located on grade in dedicated, weatherproof, sound-attenuated enclosure. One diesel fueled, generator rated at 600KW, 480Y/277V will be provided, manufactured by Caterpillar or approved equivalent. The generator will be standby rated with unit mounted radiator and be equipped with a sub-base tank capable of providing 96 hours of fuel. An exterior platform and stairs will be provided for access, due to the height of the sub-base tank.
Emergency SwitchboardThe emergency switchboard will be located in a dedicated room in the building. It is designed for a 600KW generator and a roll-up generator connection that can also serve as a load bank connection. A quick connect switchboard will be provided on site with male and female cam locks. The emergency switchboard will have a bus rating of 1000A at 480Y/277V with SPD and be manufactured by Square D, Eaton, or Siemens.
Automatic Transfer SwitchesEmergency power will be distributed throughout the building and switched automatically using automatic transfer switches (ATS). The ATS will sense power loss and signal the generator to start. Once proper frequency and voltage is reached, the ATS will transfer the load to the active power source. Three closed transition ATS’s will be provided: a 480Y/277V, 150A life safety switch, a 480Y/277V, 600A critical power switch, 480Y/277V, and a 1000A equipment branch switch. All transfer switches will be equipped with a bypass isolation feature.
UPS PowerA 208Y/120V, 50 KVA UPS will be provided for IT loads with lithium ion batteries. Individual UPS’s will be provided with each piece of radiology equipment.
DistributionPanelboards and transformers will be provided as indicated on attached single line diagram and shall have 25% spare breaker space for future expansion capability. All panelboards will be provided with copper bus bars. All life safety panels will be fused in order to achieve selective coordination and will be provided with surge protective devices as mandated by code.
In compliance with NEC 517, all panels serving patient care vicinities will have their equipment grounds bonded together.
Main electrical rooms will be segregated to separate normal and emergency power. Grounding bars will be provided for IT closets.
Wiring MethodsAll branch circuits will be installed in electrical metallic tubing (EMT), minimum ¾” diameter, where concealed in walls, above suspended ceilings, and exposed 6’ above finished floor or higher. Branch circuits routed in concrete slabs or in wet locations will be installed in intermediate metal conduit (IMC). All feeders will be installed in intermediate metal conduit (IMC). Connections to motors, transformers, and other vibrating equipment will be flexible metal conduit not to exceed 6’ in length. Conductors in feeders and branch circuits will be copper, minimum size #12 AWG, with thermoplastic insulation. All feeders and branch circuits will include copper ground conductors sized in accordance with the National Electric Code (NEC). All electrical equipment will be U.L. listed.
All circuits will be designed in accordance with the NEC, which limits the voltage drop to the farthest outlet of power to a maximum of 3% for either feeder or branch circuits, with a limit of 5% combined voltage drop.
L. LIGHTING
All lighting (both interior and exterior) will be LED for energy efficiency, low cost maintenance, and better control. Lighting levels will be designed and recommended by the Illuminating Engineering Society (IES) handbook. This will be the maximum level. The International Energy Conservation Code (IECC) requires automatic controls of lighting to turn lights off during times of vacancy. In addition, lighting is prohibited from turning on to 100% once someone enters a room. The lights can be turned on manually or automatically, but only to a level of 50%. Most spaces will have dimming controls to allow each occupant to adjust the lighting output. Areas with ample daylight will be considered to have photocells to reduce lighting output where fenestration provides adequate illumination.
Lighting controls will be IP based and networked. Room controllers will interface with a variety of wall stations, touch pads, and other systems such as fire alarm, nurse call, and patient entertainment/experience.Site lighting will be provided as part of this project and will consist of pole-top LED fixtures to provide recommended illumination on all paved surfaces. These will be controlled via a central lighting control panel located within the building. Lighting will also be provided at helipad in accordance with recommendations by a separate aviation consultant. Lighting will also be provided at the monument sign, flag poles, and potentially the spring at the entrance to the site.
M. FIRE PROTECTION
Water Supply
The building will be fully sprinklered. The systems will be supplied via a combined fire/water main as described above. Two (2) 2-1/2-inch reduced pressure principle (RPZ) backflow preventers will be provided between the municipal supply and the sprinkler control valves to allow for regular maintenance without shutting down the water supply. Two (2) 3-inch backflow preventers will be provided between the municipal supply and the domestic service to the building. Fire Sprinkler Systems
Fire sprinkler systems will include wet pipe, and dry pipe systems. Two dry pipe valves will be specified for exterior canopy at the main entries and the ambulance bay, and where required by NFPA 13. Individual sprinkler zones will be zoned to coincide with smoke barriers. All system piping will be ASTM A53 or A795, Sch 40 black steel, and be joined by threaded or grooved fittings. Preaction and dry system piping will be fabricated with cut grooves, where grooved fittings are utilized. Flexible piping to heads will be incorporated into the system.
Sprinklers located in light hazard areas, as defined by NFPA 13, and throughout all smoke compartments with patients, will be quick response. Sprinklers for all other areas will be standard response, except where specifically noted otherwise in the contract documents.
Systems will be designed and installed in accordance with NFPA 13, the requirements of Somerset County, and Chubb, the owner’s insurance carrier. All sprinkler systems will be electrically supervised by the fire alarm system, which will be provided with off-site monitoring in accordance with NFPA 72. Fire department hose valves will be located in cabinets where travel distance from the exit is greater than 200 feet and on each side of all horizontal exits, except where permitted otherwise by NFPA 14.
N. FIRE ALARM AND DETECTION SYSTEM
System Architecture
The facility will be served by a fire alarm, detection, and communication system by Honeywell, or approved equivalent. The network will also permit selective and all-call voice communication throughout all areas via recorded or live-voice announcements. The system will be monitored off-site to a UL listed supervising station. All notification appliance and signaling pathways will be Class B. Where these pathways pass through or serve multiple smoke compartments, the pathway(s) shall be provided with Level 2 survivability, similar to network pathways. Pathways, or portions thereof, passing though or serving only one smoke compartment will be provided with Level 1 performance. The final arrangement of smoke compartments, voice notification philosophy, and fire alarm system design must be coordinated with the Owner’s overall life safety plan. Accordingly, the Owner must approve all recorded messages and how they are to be broadcast during a fire event. Occupant Notification
Occupant notification will be a combination of public-mode and private-mode notification. Areas that do not provide patient care and are typically occupied by ambulatory outpatients, the general public, or facility personnel will be designated as public-mode areas. These areas would include facility service areas, main lobbies, waiting, and administrative areas. Public-mode areas are provided with voice notification intended for all occupants within the area. Private-mode areas receive voice notification intended only for facility staff. These areas would include the Emergency Department.
The overall notification philosophy is as follows:Alarm in public mode area
• General evacuation or alert message for all public mode areas
• Alert message for all private mode areas Alarm in private mode area
• General evacuation or alert message for all public mode areas
• Relocation message for private mode zone of origin• Alert message for all other private mode areas Detection
Smoke detection will be provided for many areas of the facility, including:• Cross-corridor smoke doors equipped with hold-open
devices• HVAC systems• At system control panels and subpanels• At the IT Equipment Rooms
Detection required for preaction sprinkler systems will be photoelectric smoke detectors. Integration
The fire alarm system will interface with the following fire protection and building systems:• Fire and smoke doors on magnetic hold-open• HVAC systems• Smoke dampers• Emergency generator• Preaction sprinkler systems• Facility security system/locking hardware
O. FUEL AND UTILITY SOURCE
Propane
Three (3) 1,000-gallon liquid propane tanks will be added to the existing propane tank farm on site to provide 96 hours of back-up fuel to the hot water boilers. Electricity
The utility company will provide a secondary service from a utility owned transformer on the property. The contractor will be responsible for providing a concrete pad for the transformer, as well as all wiring and conduit from the transformer secondary. At least one spare conduit beyond what is required will be provided between the transformer and the switchboard for feeder replacement in the future.
Leach Wallace Associates, Inc. Consulting Engineers
Initial MEP Pricing Items
o
Design Fee Detail
Construction Cost Estimates
Current Date September 3, 2018
EXHIBIT 10
Where To Go For CareYour healthcare provider should be your first point of
contact for most medical problems.
You get the most efficient care because they personallyknow you and your medical history.
Primary Care Office
It is always important to bring a list of thecurrent medications you are taking no matter
where you go for care.
• Best choice• Knows you and your health• Available to call 24/7
Hospital Emergency Rooms
Urgent Care Facilities• If your doctor can’t see you and your
condition can’t wait• Extended and weekend hours
• Life-threatening problems Examples: – Sudden chest pain – Sudden numbness in face, arm, or leg – Seizures – Inability to breathe – Sudden severe headache – Severe abdominal pain
• Call 911
MKT-026 (05/19)
CALL YOUR PRIMARYCARE PROVIDER FIRST
1st Choice
2nd Choice
3rd Choice
EXHIBIT 11
EXHIBIT 12
Re: Summary of Public Informational Hearing Regarding Conversion of Edward W. McCready Memorial Hospital to a Freestanding Medical Facility
EXHIBIT 13
EXHIBIT 14
Status Found
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You entered Legal Business Name: McCready Foundation
DCN/CCN 632735000NPITracking IdApplication Type 855AName FRANK COLLINSLegal Business Name MCCREADY FOUNDATIONReceived Date 2013-09-30
The status of this application is: Approved
Novitas Solutions has processed and approved this CMS-855, CMS-20134, EFT application, or Opt Out request.
Please refer to the notification letter for complete details and additional required action.
Status History
Date Status
December 13, 2013 Approved
December 2, 2013 Development Received
December 2, 2013 Development Received
November 25, 2013 In Development
October 23, 2013 In Process
Provider Lookup: B1
https://encrypt.emdhealthchoice.org/searchable/search.action[9/10/2019 11:03:37 AM]
HEALTHCHOICE
MARYLAND CHILDREN'S HEALTHPROGRAM
MARYLAND PHARMACYASSISTANCE PROGRAM
LONG TERM CARE
SPECIALTY MENTALHEALTH SERVICES
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MCCREADY FOUNDATION, INC201 HALL HWY
CRISFIELD , MD 21817(410) 968-1801
Provider Number:1604414 60NPI:1023058062HOSPITAL, ACUTE
Handicap Accessible: Y TTY: Y EPSDT Certified:N
Managed Care Organization(s):MARYLAND PHYSICIANS CARE Primary Care Physician: N Accepting New Patients:YPRIORITY PARTNERS Primary Care Physician: N Accepting New Patients:Y
MCCREADY HOSPITAL201 HALL HWY
CRISFIELD , MD 21817(410) 968-1200
Provider Number:0109738 60NPI:1881683423HOSPITAL, ACUTE
Handicap Accessible: Y TTY: Y EPSDT Certified:N
Managed Care Organization(s):AETNA BETTER HEALTH Primary Care Physician: N Accepting New Patients:YPRIORITY PARTNERS Primary Care Physician: N Accepting New Patients:Y
MCCREADY MEMORIAL HOSPITAL201 HALL HWY
CRISFIELD , MD 21817(410) 968-1200
Provider Number:0016594 61NPI:1881683423HOSPITAL, ACUTE
EPSDT Certified:N
Managed Care Organization(s):JAI MEDICAL SYSTEMS MCO Primary Care Physician: N Accepting New Patients:Y
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EXHIBIT 15
Status Found
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You entered Legal Business Name: Peninsula Regional Medical Center
DCN/CCN 383370537NPI 1780689463Tracking Id T072020180001544Application Type 855ANameLegal Business Name PENINSULA REGIONAL MEDICAL CENTERReceived Date 2018-12-03
The status of this application is: Approved
Novitas Solutions has processed and approved this CMS-855, CMS-20134, EFT application, or Opt Out request.
Please refer to the notification letter for complete details and additional required action.
Status History
Date Status
December 14, 2018 Approved
December 14, 2018 Development Received
December 5, 2018 In Development
December 5, 2018 In Process
Provider Lookup: B1
https://encrypt.emdhealthchoice.org/searchable/search.action[9/10/2019 11:30:15 AM]
HEALTHCHOICE
MARYLAND CHILDREN'S HEALTHPROGRAM
MARYLAND PHARMACYASSISTANCE PROGRAM
LONG TERM CARE
SPECIALTY MENTALHEALTH SERVICES
WAIVER PROGRAMS
LISTING OF LOCALDEPARTMENTS OF SOCIAL
SERVICES
MEDICAL PROGRAMS HOME
FOR PROVIDERS:WHAT SHOULD I DO IF MY
INFORMATION IS INCORRECT?
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Last Name: Peninsula Provider Location: State of MDShow only PCP? No
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PENINSULA HOME CARE SALISBURY1001 MOUNT HERMON RDSTE 200SALISBURY , MD 21804(410) 543-7550
Provider Number:0035271 61NPI:1811976418HOSPITAL, ACUTE
Handicap Accessible: Y TTY: Y EPSDT Certified:N
Managed Care Organization(s):MARYLAND PHYSICIANS CARE Primary Care Physician: N Accepting New Patients:NPRIORITY PARTNERS Primary Care Physician: N Accepting New Patients:YU M HEALTH PARTNERS Primary Care Physician: N Accepting New Patients:N
PENINSULA REGIONAL MED CENTER30434 MOUNT VERNON RD
PRINCESS ANNE , MD 21853(410) 543-4705
Provider Number:0011207 71NPI:1780689463HOSPITAL, ACUTE
Handicap Accessible: Y TTY: Y EPSDT Certified:N
Managed Care Organization(s):PRIORITY PARTNERS Primary Care Physician: N Accepting New Patients:Y
PENINSULA REGIONAL MED CENTER100 E CARROLL ST
SALISBURY , MD 21801(410) 546-6400
Provider Number:0011207 60NPI:1780689463HOSPITAL, ACUTE
Handicap Accessible: Y TTY: Y EPSDT Certified:N
Managed Care Organization(s):MARYLAND PHYSICIANS CARE Primary Care Physician: N Accepting New Patients:NPRIORITY PARTNERS Primary Care Physician: N Accepting New Patients:YU M HEALTH PARTNERS Primary Care Physician: N Accepting New Patients:N
PENINSULA REGIONAL MEDICAL CEN100 E CARROLL ST
SALISBURY , MD 21801(410) 546-6400
Provider Number:0174963 60NPI:1124005053HOSPITAL, ACUTE
EPSDT Certified:N
Managed Care Organization(s):UNITEDHEALTHCARE Primary Care Physician: N
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EXHIBIT 16
